AFFORDABLE CARE ACT Tracking Survey

Most Adults with Marketplace or Medicaid Coverage Continue to Be Satisfied with Their Health Insurance, But Many Remain Uninsured

The latest wave of The Commonwealth Fund Affordable Care Act (ACA) Tracking Survey indicates that the share of working age adults who are uninsured was 12.7 percent in February–April 2016, compared with 19.9 percent just before the law’s major coverage expansions went into effect. Still, 24 million adults lack health insurance coverage. While awareness of the health insurance marketplaces continues to increase among the uninsured, affordability remains a key issue as to why adults remain uninsured.

Latest Results
Coverage
12.7%
The uninsured rate among adults 19–64 has declined from 19.9 percent in Jul–Sep 2013.
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Remaining Uninsured
24 m
24 million adults ages 19–64 remain uninsured.

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Affordability
49%
Half of adults who pay all or some of their premium,
are aware of their premium amounts and are in
marketplace plans view their premiums as affordable
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Value of Coverage
61%
Six in 10 marketplace and new Medicaid enrollees who have used their coverage said they would have not have been able to access or afford this care prior to getting their insurance.
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Explore Survey

Coverage

12.7%
Current uninsured rate among working-age adults in the U.S., down from 19.9 percent
in July–September 2013
18.1%
Current uninsured rate among
young adults (ages 19–34) down
from 28.4% in July–September 2013

The Uninsured Rate for U.S. Adults Has Fallen Since 2013

The survey finds declines in the rate of uninsurance among U.S. adults since the law’s major reforms took effect in 2014.

Uninsured rates in the United States

The percentage of adults ages 19–64 who are uninsured fell to 12.7 percent in February–April 2016. This represents an estimated decline of 13 million uninsured adults since the coverage expansions took effect.

Percent uninsured see details

Adults ages 19–64

Coverage gains across all age groups in
the wake of the law’s insurance expansions

While young adults have made dramatic gains in coverage since the law took effect, in this wave of the survey there was no significant change from the prior year in the uninsured rate among adults under age 50.

Percent uninsured by age see details

Adults ages 19–64

Low- and moderate-income groups have made significant gains in coverage since the major expansions took effect

Uninsured rates declined steeply for low- and moderate-income adults in 2014. Since then uninsured rates for adults below 249 percent of poverty remain about the same. People in these income groups experienced the greatest gains in coverage.

Percent uninsured by income see details

Adults ages 19–64


More than half of adults who enrolled in marketplace plans or Medicaid were uninsured before getting their new plan

Insurance status of current marketplace and Medicaid enrollees prior to getting new plan (Feb–Apr 2016) see details

Adults ages 19–64 who are currently enrolled in marketplace coverage
or have had Medicaid for less than three years


The majority of new enrollees in marketplace or
Medicaid had been uninsured for a long time

Sixty-two percent of adults newly covered by Medicaid and 45 percent of those with a marketplace plan were uninsured before they enrolled. Of this group, 59 percent of those with a marketplace plan and 49 percent of those enrolled in Medicaid had been without insurance for two years or more.

Adults ages 19–64 who were uninsured before gaining
their Medicaid or marketplace coverage
see details


*Includes those who reported never having had insurance.


Seven in 10 adults who had employer insurance for less than a year previously had insurance through the marketplace

Among adults in the survey who had had employer coverage for less than a year,
7 percent reported that they had marketplace coverage prior to gaining their
employer coverage and 11 percent had been enrolled in Medicaid.

Type of coverage prior to current employer coverage (Feb–Apr 2016) see details


Adults ages 19–64 who have had employer insurance for less than a year

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remaining uninsured

Who Are the Remaining Uninsured?

The remaining uninsured are more likely to be young, Latino, low-income, and/or work in small firms.

Latinos have become a growing share of the uninsured, rising from 29 percent in 2013 to 40 percent in 2016. Thirty-nine percent of uninsured adults have incomes below the federal poverty level, twice the rate of their overall representation in the adult population.

Composition of the remaining uninsured population see details

By Age

By Race

By Income

By Employer Size

Uninsured adults 19-64

Bars may not sum to 100 percent because of “don‘t know” responses or refusal to respond.

Are Uninsured Americans Aware of the Health Insurance Marketplaces?

While awareness of the marketplaces and financial assistance to help pay for health insurance rose significantly among uninsured adults from 2013 to 2014, since 2014 it has leveled off.

Awareness of the health insurance marketplaces

More than six of 10 American adults who are uninsured are aware of the new marketplaces where they can shop for health plans.

Percent who are aware of marketplaces,
July–Sept. 2013 to Feb–April 2016
see details

Uninsured adults ages 19–64

Note: Question wording was slightly different between the four surveys.


Awareness of financial assistance to pay for health insurance

Half of uninsured adults are aware that financial assistance for health insurance is available under the Affordable Care Act.

Percent who are aware of financial assistance,
July–Sept. 2013 to Feb.–April 2016
see details

Uninsured adults ages 19–64

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Affordability

Are Americans Using the Health Insurance Marketplaces?

A quarter of all U.S. adults had visited a marketplace to shop for health insurance by February—April 2016.

Percent who visited marketplace,
April–June 2014 to Feb.–April 2016
see details

Adults ages 19–64


How Easy Is It for People
to Use the Marketplaces?

Adults who visited the marketplaces who were eligible for coverage found it easy to compare benefits and costs of plans. Fewer found it as easy to compare which doctors, clinics, and hospitals were available.

About three of five adults who visited the marketplace and were eligible for marketplace coverage said it was very or somewhat easy to compare the premium costs, while half said it was easy to compare different insurance plans’ covered benefits.

How easy or difficult was it to... (percent) see details

Adults ages 19–64 who went to the marketplace and are marketplace eligible**

*Potential out-of-pocket costs from deductibles and copayments.

**Marketplace eligible includes adults in expansion states who are above 138% FPL
and adults in non-expansion states who are above 100% FPL.

Bars may not sum to 100 percent because of “don‘t know” responses or refusal
to respond; segments may not sum to subtotals because of rounding.


How Do Visitors View Their Experience Trying to Get Health Insurance Through the Marketplace in Their State?

Two of five adults who went to the marketplace describe their experience as good or excellent.

Rating experience with the marketplace (percent) see details

Adults ages 19–64 who went to the marketplace.

Bars may not sum to 100 percent because of “don‘t know” responses or refusal to respond; segments may not sum to subtotals because of rounding.


What Are People Paying for Health Coverage?

Adults with single policy plans in the marketplace who have incomes under 250 percent of poverty paid monthly premiums comparable to those with employer coverage.

About 57 percent of adults with marketplace coverage and 60 percent with an employer plan paid either nothing for their policies or less than $125 per month.

Premium distributions (percent) see details


Adults ages 19–64 with single policies

FPL refers to federal poverty level. 250% of the poverty level is $29,425 for an individual or $60,625 for a family of four.

Bars may not sum to 100 percent because of rounding.


Half of Adults with Marketplace Coverage Found It Easy to Pay Their Premiums

Ability to afford premium costs (percent) see details


Adults ages 19–64 who pay all or some of premium and are aware of their premium amount.

FPL refers to federal poverty level. 250% of the poverty level is $29,425 for an individual or $60,625 for a family of four.

Bars may not sum to indicated total because of rounding; segments may not sum to 100 because of "don't know" responses or refusal to respond


Low-Income Adults with Marketplace Coverage Are Less Likely to Have High Deductibles Than Those with Higher Incomes

Three of 10 low-income adults with marketplace coverage have deductibles of $1,000 or more, while nearly seven of 10 higher-income adults with marketplace coverage have high deductibles.

Percent of adults who have deductibles of $1,000 or more see details

Adults ages 19–64 with marketplace coverage

FPL refers to federal poverty level. 250% of the poverty level is $29,425 for an individual or $60,625 for a family of four.


Reasons Consumers Switched Marketplace Plans Are Consistent with Most Important Factors in Plan Selection

Reasons changed plans, Feb–April 2016 (percent) see details


Adults ages 19–64 who changed marketplace plans*

Respondents allowed more than one response.

*46% of adults ages 19-64 who have had marketplace coverage
since before January 2016 switched plans since enrolling.


Most Adults Stayed in the Same Marketplace Plan Because It Was Easier to Do So

Reasons kept the same plan, Feb–April 2016 (percent) see details


Adults ages 19–64 who stayed in the same marketplace plan*

Respondents allowed more than one response.

*50% of adults ages 19-64 who have had marketplace coverage since before January 2016 stayed in the same plan since enrolling.


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Value of Coverage

The Value of New Health Insurance Coverage

Adults Are Using Their Marketplace or
Medicaid Coverage to Access Health Care

Since the ACA’s major coverage expansions went into effect, there has been concern about difficulty new enrollees might have finding doctors, getting timely appointments, and whether they would be satisfied with their choice of doctors because of insufficient provider capacity or limited provider networks. The survey asked adults who had newly enrolled in coverage about their experience using their new health plans. In the latest survey, 72 percent of adults who gained marketplace or Medicaid coverage under the ACA said they had used their plans to go to a doctor or hospital, or fill a prescription. Of those, 61 percent said they would not have been able to access or afford this care prior to getting their marketplace or Medicaid coverage.

Percent who used their marketplace
or Medicaid coverage to go to
a doctor or hospital, or fill
a prescription
see details
Adults ages 19–64 who are currently enrolled in marketplace coverage or have had Medicaid since expansion
Percent who would not have been able
to access and/or afford this care without their new plan
see details
Adults ages 19–64 who are currently enrolled in marketplace coverage or have had Medicaid since expansion and have used their new health insurance plan

Fifty-three percent of those who found a primary care or general doctor got an appointment relatively quickly.

Percent who got appointment within two weeks see details
53%
Adults ages 19–64 who are currently enrolled in marketplace coverage or had had Medicaid for less than three years and tried to find a primary care doctor or general doctor since getting new coverage

More than half of adults with marketplace or Medicaid coverage who needed to see a specialist were able to get an appointment within two weeks.

Percent who got specialist appointment within two weeks see details
60%
Adults ages 19–64 who are currently enrolled in marketplace coverage or have had Medicaid for less than three years and needed to see a specialist.

Fifty-eight percent of adults with marketplace or Medicaid coverage who tried to find a primary care physician or general doctor found it very or somewhat easy to do so.

Percent who said it was somewhat or very easy to find a new primary care or general doctor see details
Adults ages 19–64 who are currently enrolled in marketplace coverage or had had Medicaid since expansion and tried to find a primary care doctor or general doctor since getting new coverage

Adults with Marketplace Plans or Medicaid Held Positive Views of Their New Health Insurance

The survey asked adults who had newly enrolled in ACA marketplace or Medicaid coverage this year about their views of their new health plans. In the latest survey, 84 percent of adults who have had marketplace or Medicaid coverage under the ACA for two months or less said their ability to get the health care they need has improved or stayed the same. More than eight of 10 (82%) of marketplace and Medicaid enrollees who have had coverage for three years or less were very or somewhat satisfied with it and seven of 10 (71%) rated their health insurance coverage as good, very good, or excellent.

Percent who said their ability to get the health care that they need has improved or stayed the same see details
84%
Adults ages 19–64 who have had a private plan through the marketplace or Medicaid for two months or less
Percent who said they are very or somewhat satisfied with their health insurance see details
82%
Adults ages 19–64 who are currently enrolled in marketplace coverage or have had Medicaid for less than three years



Percent who rated their health insurance coverage as good, very good, or excellent see details
71%
Adults ages 19–64 who are currently enrolled in marketplace coverage or have had Medicaid for less than three years.

A Majority of Adults With Marketplace Coverage Were Confident They Could Afford Care They Needed

Confidence in ability to afford care they need, Feb–Apr 2016 (percent) see details

Adults ages 19–64

Segments may not sum to indicated total because of rounding; bars may not sum to 100 percent because of "don't know responses" or refusal to respond.

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