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Why Do Millions of U.S. Adults Remain Uninsured?

Since the health care reform law went into effect, the share of the U.S. population under age 65 without health insurance has fallen to an historic low of 11.9 percent. Yet about 24 million people still lack coverage. The U.S. Department of Health and Human Services is currently reaching out to the millions of uninsured who are eligible for subsidies as it prepares for the next marketplace open enrollment period, which begins on Nov. 1, 2016. The Commonwealth Fund’s Affordable Care Act (ACA) Tracking Survey looked at the reasons why so many Americans still lack health insurance.


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1: The ACA excludes undocumented immigrants.

People who are not legal U.S. residents are barred from Medicaid or marketplace coverage.


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2: Nineteen states have not expanded Medicaid eligibility.

A 2012 Supreme Court decision made the ACA’s Medicaid expansion for people with incomes up to about $16,000 optional for the states. Nineteen states have chosen not to expand eligibility, although several of these are considering doing so.


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3: Many people still don’t know about the health insurance marketplaces. 

Of those still uninsured, only 52 percent are aware they can shop for plans on the health insurance marketplaces.


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4: Affordability is a concern.  

Nearly two-thirds of uninsured adults who are aware of the marketplaces said they had not shopped for a health plan because they didn’t think they would be able to afford the coverage.


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5: Selecting a plan can be difficult.

Fewer than half of people who have not enrolled said it was easy to compare plans based on covered benefits covered, out-of-pocket costs, and provider networks.


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6: Many aren’t getting the help they need. 

People who enrolled were much more likely to have received assistance—through a telephone hotline, insurance broker, or health care navigator—than those who did not enroll.

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