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Feb 28, 2018

Three of 10 Marketplace and Medicaid Enrollees Are Concerned About Losing Coverage

Commonwealth Fund Survey Also Finds 92 Percent of U.S. Adults Believe Americans Have Right to Affordable Health Care

New York, NY, March 1, 2018 — About one-third (36%) of Americans who have health coverage through the Affordable Care Act’s marketplaces and 27 percent of people with Medicaid are pessimistic they will be able to keep their coverage in the future. Of those, nearly half point to the federal government as the main source of their concern – believing either the Trump administration won’t continue implementing the ACA (32%) or Congress will repeal it (15%), a new Commonwealth Fund survey finds.

The survey, conducted between November 2 and December 27, 2017, is the most recent look at people’s perspectives on the marketplaces, Medicaid, and other health care issues. It is the sixth in the Commonwealth Fund’s series tracking the ACA. According to the report, Americans’ Views on Health Care at the End of a Turbulent Year, despite federal efforts to weaken the law, 11.8 million people selected plans through the marketplaces, about 3.7 percent fewer than during the prior year.

“This year’s enrollment numbers are impressive considering the uncertainty that surrounded the law most of the year, but we found that some people are concerned about being able to keep their coverage in the future,” said Sara Collins, Vice President for Health Care Coverage and Access at the Commonwealth Fund and the study’s lead author. “Congress and the administration could allay consumers’ concerns about their health insurance by signaling support for the marketplaces and Medicaid.”

Support for Universal Health Coverage

The survey finds that a wide majority of U.S. working-age adults (92%), regardless of political affiliation, believe that all Americans should have the right to affordable health care. This includes 99 percent of Democrats, 82 percent of Republicans, and 92 percent of independent voters.

Additional Survey Findings

  • Uninsured Rate Holds Steady in 2017: Fourteen percent of working-age adults were uninsured at the end of 2017, unchanged from six months earlier.
  • Concerns About Affordability and ACA Repeal: A majority (71%) of uninsured adults who were aware of the marketplaces did not intend to visit the marketplaces to shop for coverage this year because they did not think they could afford it. Twenty-three percent didn’t plan to visit because they believed the ACA would be repealed, and 16 percent thought the government no longer required them to have health insurance. 
  • Support for Paying into Medicare: Most U.S. working-age adults (87%) believe paying into Medicare over a lifetime is a fair way to ensure everyone has access to care starting at age 65. This includes 92 percent of Democrats, 84 percent of Republicans, and 87 percent of independents. There were no differences by age, income, or region of the country. 
  • Awareness of the Marketplaces: About one-third (35%) of uninsured adults are not aware of the marketplaces, compared to 21 percent of the overall population. The researchers say this indicates the potential to lower the uninsured rate through increased outreach efforts.

This survey is an important reminder that people want and need access to health care,” said Commonwealth Fund President David Blumenthal, M.D. “The Affordable Care Act was an important step in moving our health care system toward universal coverage, and it is critical that we protect the gains in coverage we have made because of the law.”




The Commonwealth Fund Affordable Care Act Tracking Survey, November-December 2017, was conducted by SSRS from November 2-December 27, 2017. The survey consisted of telephone interviews in English or Spanish and was conducted among a random, nationally representative sample of 2,410 adults, ages 19 to 64, living in the United States. Overall, 122 interviews were conducted on landline telephones and 2,288 interviews on cellular phones.

This survey is the sixth in a series of Commonwealth Fund surveys to track the implementation and impact of the Affordable Care Act. Like the prior waves of the survey, the November-December 2017 sample was also designed to increase the likelihood of surveying respondents who had gained coverage under the ACA. Interviews in Wave 6 were obtained through two sources: (1) stratified RDD sample, using the same methodology as in Waves 1, 2, 3, 4, and 5; and (2) households reached through the SSRS Omnibus where interviews were previously completed with respondents ages 19 to 64 who were uninsured, had individual coverage, had a marketplace plan, or had public insurance.

As in all waves of the survey, SSRS oversampled adults with incomes under 250 percent of poverty to further increase the likelihood of surveying respondents eligible for the coverage options as well as allow separate analyses of responses of low-income households.

The data are weighted to correct for oversampling uninsured and direct purchase respondents, the stratified sample design, the overlapping landline and cellular phone sample frames, and disproportionate nonresponse that might bias results. The resulting weighted sample is representative of the approximately 190 million U.S. adults ages 19 to 64. The survey has an overall margin of sampling error of +/– 2.7 percentage points at the 95 percent confidence level.

Publication Details


Feb 28, 2018


Mary Mahon, Former Vice President, Public Information, The Commonwealth Fund

[email protected]