Health Care Coverage and Access

In the more than five years since enactment of the most significant health reform legislation in half a century, it’s now clear that millions of Americans are benefiting from the insurance coverage expansions, premium and cost-sharing subsidies, consumer protections, and market reforms ushered in by the Affordable Care Act (ACA).

During that time, The Commonwealth Fund’s Health Care Coverage and Access program, led by Vice President Sara Collins, has monitored the law's implementation and impact through its sponsorship of population-based survey research, analyses of insurance market trends, and tracking of state and federal approaches to the law’s coverage provisions. For example, the latest Commonwealth Fund Biennial Health Insurance Survey——the longest-running nonfederal survey of U.S. health coverage——revealed that uninsured rates have declined to their lowest levels in more than a decade, and that the number of Americans unable to get needed care because of cost is the lowest since the survey was first fielded in 2003.

Given the U.S. Supreme Court's most recent ruling, it appears the ACA is here to stay. That doesn’t mean, however, that the longstanding problems with the U.S. health insurance system are a thing of the past. Reaching the millions of adults who still remain without coverage and health care security is one big challenge; another is ensuring that those who are insured, particularly people with low and moderate incomes, can afford their health plans and their health care. Recent Commonwealth Fund research has found that the increasing size and prevalence of high deductibles and copayments in private health plans, including employer-based plans, are leading many people with low and moderate incomes to avoid or delay needed health care.

With the maturation of the health insurance marketplaces and evolution of state Medicaid programs, the Fund’s Health Care Coverage and Access program continues to deliver up-to-date information on the state of health coverage in the U.S. to federal and state policymakers, consumer groups, the media, and other key stakeholders. Its efforts include:

  • Providing timely information about the ACA’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 key 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.

Expert spotlight

Sara Collins
Sara R. Collins
Vice President, Health Care Coverage and Access, The Commonwealth Fund