Health Care Coverage and Access

The number of people without health insurance in the United States climbed steadily over the past decade, rising from 37 million in 2000 to 50 million in 2010. In 2011, however, the picture began to brighten, as the number of uninsured declined to 48.6 million people―the largest one-year drop in the past 10 years. This improvement was likely driven by an increase in the number of young adults who were enrolled in their parents’ health plan, a direct result of one of the Affordable Care Act’s first reforms.

The recent gains in coverage for young adults foreshadow the further progress expected once the law’s major insurance provisions are fully implemented over the next few years. Millions of Americans will soon be able to enroll in private subsidized health plans offered through the new state insurance marketplaces, while others will become eligible for coverage through the Medicaid program. Many people will also benefit from a panoply of new insurance market reforms, including a new standard for essential health benefits and bans on insurers from charging people more based on health or gender or barring enrollment because of a preexisting health condition. In all, some 37 million Americans are expected to gain new or more affordable coverage over the next decade.

As the central coverage reforms go into effect, The Commonwealth Fund’s Health Care Coverage and Access program will furnish policymakers and key stakeholders with timely analysis to inform successful implementation. Activities will include:

  • Providing timely information about the law’s reforms and the status of their implementation. 
  • Tracking enrollment and people’s experiences with the new insurance options. 
  • Evaluating the effects of insurance reforms and state and federal innovation on the extent and quality of health coverage, access to health care, changes in employer-based coverage, affordability of premiums and out-of-pocket costs, health plan competition, innovation in insurance markets, and sustainability of the insurance marketplaces. 
  • Analyzing and developing national and state short-term policy solutions to address implementation issues as they arise. 
  • Identifying gaps in the law and its implementation that may leave some groups of people without coverage or adequate protection from costs. 


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