AFFORDABLE CARE ACT Tracking Survey

Most Adults with Marketplace or Medicaid Coverage Continue to Be Satisfied with Their Health Insurance

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. Sixty-one percent of those who have used coverage they obtained through the ACA are getting health care that they would not have been able to afford or access previously. In addition, nearly three of five ACA enrollees who tried to find a new primary care doctor found it easy to find one, and three of five who needed to see a specialist waited two weeks or less to get an appointment.

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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Value of Coverage
82%
More than 8 of 10 adults who are currently insured through the ACA marketplaces or newly insured in Medicaid are satisfied with their health insurance.

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Coverage
53%
More than half of adults were uninsured prior to getting their Medicaid or marketplace coverage.
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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 3 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 ten 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–April 2016) see details


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

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Awareness

63%
Uninsured adults who are aware
of health insurance marketplaces in 2015
52%
Uninsured adults who are aware of financial
assistance to pay for health insurance in 2015

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, it did not change between 2014 and 2015.

Awareness of the health insurance marketplaces

Nearly 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 March–May 2015
see details

Adults ages 19–64 who are uninsured

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


Awareness of financial assistance to pay for health insurance

Fewer than half of uninsured adults are aware that financial assistance for health insurance is available under the Affordable Care Act, unchanged from April–June 2014.

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

Adults ages 19–64 who are uninsured

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

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Use & experience

Are Americans Using the Health Insurance Marketplaces?

A quarter of all U.S. adults had visited a marketplace to shop for health insurance by March–May 2016.

Rates of visits were highest among young adults ages 19—34 (29%) and adults with incomes under 250 percent of poverty (31%).

Percent who visited marketplace,
Apr–June 2014 to March–May 2015
see details

Adults ages 19–64


How Easy Is It for People
to Use the Marketplaces?

Adults who visited the marketplaces 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 two-thirds of adults who obtained marketplace coverage said it was very or somewhat easy to compare the premium costs or the benefits covered of different insurance plans. In contrast, just over 2 of 5 adults who did not enroll said it was easy to make these comparisons between plans.

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

Adults ages 19–64 who went to the marketplace

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

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 Rate the Marketplaces?

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

Those who enrolled gave a higher rating to their marketplace experience than those who did not enroll. More than half (52%) of adults who obtained coverage rated their experience getting health insurance as good or excellent compared with just 18 percent of those who did not enroll.

Rating experience with the marketplace, October 2013 to March–May 2015 (percent) see details

Adults ages 19–64 who went to the marketplace

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


What Are People Paying for Health Coverage?

Adults with marketplace coverage with incomes under 250 percent of poverty paid monthly premiums comparable to those with employer coverage.

About 60 percent of adults with marketplace coverage and 56 percent with an employer plan paid either nothing for their policies or less than $125 per month.

Premium distributions, March–May 2015 (percent) see details

Adults ages 19–64 with single policies

FPL refers to federal poverty level. 250% of the poverty level is $29,175 for an individual or $59,625 for a family of four.

Bars may not sum to 100 percent because of rounding.

“All adults” categories include adults who do not provide their income and may therefore not be the average of adults below and above 250% FPL.


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

Ability to afford premium costs March–May 2015 (percent) see details

Adults ages 19–64 who pay all or some of premium

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


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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 2 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 or Get High-Quality Care

Confidence in ability to afford care they need, Apr–June 2014 to March–May 2015 (percent) see details

Adults ages 19–64

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

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