The Uninsured at the Starting Line: Findings from the 2013 Kaiser Survey of Low-Income Americans and the ACA
Kaiser Commission on Medicaid and the Uninsured. The Uninsured: A Primer- Key Facts about Health Insurance on the Eve of Coverage Expansions (Washington, DC: Kaiser Family Foundation), October 23, 2013. Available at: https://www.kff.org/uninsured/report/the-uninsured-a-primer-key-facts-about-health-insurance-on-the-eve-of-coverage-expansions/
Background: The Challenge of Gaining Insurance Coverage Prior to the ACA
Care without Coverage: Too Little, Too Late, Committee on the Consequences of Uninsurance, Board on Health Care Services, Institute of Medicine, National Academy Press, 2002
J. Hadley, J. Holahan, T. Coughlin, and D. Miller, 2008 “Covering The Uninsured In 2008: Current Costs, Sources Of Payment, And Incremental Costs” Health Affairs 27 (5) w399 (published online 25 August 2008).
G. Anderson, 2007, “From ‘Soak The Rich’ To ‘Soak The Poor’: Recent Trends In Hospital Pricing.” Health Affairs 26(4): 780-789.
D. Himmelstein et al., 2009. “Medical bankruptcy in the United States, 2007: results of a national study.” Am J Med. 122(8): 741-6. Available at: http://www.pnhp.org/new_bankruptcy_study/Bankruptcy-2009.pdf
I. Patterns of Coverage and the Need for Assistance
Some states had expanded coverage to parents at higher income levels or provided coverage to adults without children. See http://www.kff.org/medicaid/fact-sheet/medicaid-eligibility-for-adults-as-of-january-1-2014/ for more detail on pre- and post-ACA Medicaid eligibility for adults.
Samantha Artiga and Jessica Stephens, Kaiser Commission on Medicaid and the Uninsured, Martha Heberlein, Tricia Brooks, and Joan Alker, Georgetown Center for Children and Families, Getting into Gear for 2014: Findings from a 50-State Survey of Eligibility, Enrollment, Renewal, and Cost-Sharing Policies in Medicaid and CHIP, 2012-2013, (Washington, DC: Kaiser Family Foundation), January 2013. Available at: http://www.kff.org/medicaid/report/getting-into-gear-for-2014-findings-from-a-50-state-survey-of-eligibility-enrollment-renewal-and-cost-sharing-policies-in-medicaid-and-chip-2012-2013/
Collins S, et al. 2012. “Gaps in Health Insurance: Why So Many Americans Experience Breaks in Coverage and How the Affordable Care Act Will Help.” The Commonwealth Fund. Available at: http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2012/Apr/
1594_collins_gaps_in_hlt_ins_tracking_brief_v2.pdf; Cassedy A, Fairbrother G, and Newacheck PW. 2008. “The Impact of Insurance Instability on Children’s Access, Utilization, and Satisfaction with Health Care. Ambulatory Pediatrics. 8(5):321-8.
II. What to Look for in Enrolling in New Coverage
Artiga and Stephens, Getting into Gear.
Includes people who had a choice of plans and reported that they made the choice themselves.
Zhou, C. and Zhang, Y. (2012). The vast majority of Medicare Part D beneficiaries still don’t choose the cheapest plans that meet their medication needs. Health Affairs, 31: 2259-2264; McLaughlin, C.G., Chernew, M., & Taylor, E.F. (2002). Medigap premiums and Medicare HMO enrollment. Health Services Research 37: 1445-1468.
Kaiser Commission on Medicaid and the Uninsured. Oral Health and Low-Income Nonelderly Adults: A Review of Coverage and Access (Washington, DC: Kaiser Family Foundation), June 2012. Available at: http://www.kff.org/medicaid/issue-brief/access-to-affordable-dental-care-gaps-for/
III. Gaining Coverage, Getting Care
Care without Coverage: Too Little, Too Late, Committee on the Consequences of Uninsurance, Board on Health Care Services, Institute of Medicine, National Academy Press, 2002.
Coverage Matters: Insurance and Health Care, Committee on the Consequences of Uninsurance, Board on Health Care Services, Institute of Medicine, National Academy Press, 2001.
Julia Paradise and Rachel Garfield, What is Medicaid’s Impact on Access to Care, Health Outcomes, and Quality of Care? Setting the Record Straight on Evidence (Washington, DC: Kaiser Commission on Medicaid and the Uninsured), August 2, 2013. Available at: https://www.kff.org/medicaid/issue-brief/what-is-medicaids-impact-on-access-to-care-health-outcomes-and-quality-of-care-setting-the-record-straight-on-the-evidence.
Wilper AP, Woolhandler S, Lasser KE, McComick D, Bor DH, Himmelstein DU. Hypertension, diabetes, and elevated cholesterol among insured and uninsured US adults. Health Affairs. 2009;28(6):w1151-9.
Kaiser Commission on Medicaid and the Uninsured. Community Health Centers in an Era of Health Reform: An Overview and Key Challenges to Health Center Growth (Washington, DC: Kaiser Family Foundation), March 1, 2013. Available at: https://www.kff.org/health-reform/issue-brief/community-health-centers-in-an-era-of-health-reform-overview/
IV. Health Coverage and Financial Security
Kaiser Commission on Medicaid and the Uninsured. The Medicaid Medically Needy Program: Spending and Enrollment Update (Washington, DC: Kaiser Family Foundation), December 30, 2012. Available at: http://www.kff.org/medicaid/issue-brief/the-medicaid-medically-needy-program-spending-and/
V. Poised at the Starting Line
Kaiser Commission on Medicaid and the Uninsured. Key Lessons from Medicaid and CHIP Outreach and Enrollment Under the Affordable Care Act (Washington, DC: Kaiser Family Foundation), June 2013. Available at: https://www.kff.org/medicaid/issue-brief/key-lessons-from-medicaid-and-chip-for-outreach-and-enrollment-under-the-affordable-care-act/
In this section, we exclude uninsured adults who are undocumented immigrants, as this group is ineligible for coverage under the law. See Methods for more detail on determining immigration status based on survey responses.
Kaiser Family Foundation Health Tracking Poll (conducted January 14-21, 2014); available at https://www.kff.org/health-reform/poll-finding/kaiser-health-tracking-poll-january-2014/
45 C.F.R. § 156.1240
“Health Centers to Help Uninsured Americans Gain Affordable Health Coverage,” Health and Human Services, July 10, 2013. Available at: http://www.hhs.gov/news/press/2013pres/07/20130710a.html
Kaiser Commission on Medicaid and the Uninsured. Fast Track to Coverage: Facilitating Enrollment of Eligible People into the Medicaid Expansion (Washington, DC: Kaiser Family Foundation), November 19, 2013. Available at: http://www.kff.org/medicaid/issue-brief/fast-track-to-coverage-facilitating-enrollment-of-eligible-people-into-the-medicaid-expansion/
Varney, Sarah. “Emergency Rooms Are Front Line For Enrolling New Obamacare Customers.” Kaiser Health News/NPR, January 14, 2014; available at: http://www.kaiserhealthnews.org/stories/2014/january/14/signing-up-for-obamacare-in-the-er.aspx.
Conclusion and Policy Implications
Kaiser Commission on Medicaid and the Uninsured, The Coverage Gap: Uninsured Poor Adults in States that Do not Expand Medicaid (Washington, DC: Kaiser Family Foundation), October 23, 2013. Available at: https://www.kff.org/health-reform/issue-brief/the-coverage-gap-uninsured-poor-adults-in-states-that-do-not-expand-medicaid/
In capturing family size, we include all members of the respondents’ immediate family, including themselves, spouse (if married), and any dependents, as well as parents if the respondent is a dependent. These groupings mimic “health insurance units” that are used to determine eligibility for Medicaid and Marketplace coverage.
“Status of State Action on Medicaid Expansion Decision, 2014,” Kaiser Family Foundation State Health Facts. Retrieved January 29, 2014: http://www.kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/