Chart adapted from The Commonwealth Fund’s report, Americans’ Experience with ACA Marketplace and Medicaid Coverage: Access to Care and Satisfaction, May 2016.


A Commonwealth Fund survey reveals that many more American adults have health insurance and access to care as a result of the Affordable Care Act (ACA), and gains have been greatest for lower-income people or those who are newly enrolled in Medicaid. Despite this progress, however, lower income adults remain much more likely to be uninsured than wealthier Americans.

As shown in the graph, the overall uninsured rate dropped from 19.9% in 2013 to 12.7% today. The uninsured rates dropped steeply for low-income people—those earning less than 138% of the federal poverty level (FPL).

The ACA has improved access to care for many newly insured adults. About 60% of adults newly enrolled in either Medicaid or a marketplace plan who have used their insurance for health care report that they would not have been able to access or afford these medical services when they didn’t have health insurance. Lower-income adults, Medicaid enrollees and the previously uninsured were most likely to say that they would not have been able to access or afford care before. Satisfaction with marketplace and Medicaid coverage is relatively high. In 2016, 88% of new Medicaid enrollees and about 77% of marketplace enrollees said that they are somewhat satisfied or very satisfied with their health insurance. About 60% said that it was somewhat easy or very easy to find a primary care doctor.

However, as the graph depicts, disparities in insurance coverage still exist between lower-income and higher-income Americans. The uninsured rate is about ten times higher among those living in poverty (<138% FPL) than among higher earners (400% FPL or more). The Commonwealth Fund comments that this “chasm in insurance coverage between lower- and higher-income adults remains troubling.”

According to the Kaiser Family Foundation, the high cost of insurance is one of the main reasons that people remain uninsured post-ACA implementation. Many low-income people in the 19 states that have not expanded their Medicaid program to cover all low-income adults remain uninsured. In these states, Medicaid eligibility is generally limited to low-income pregnant women and certain low-income parents. Florida, where 1199SEIU represents over 22,000 hospital and nursing home workers, has not expanded Medicaid. In fact, a large proportion of low-income people in these 19 states fall into a coverage gap, with incomes that fall above Medicaid eligibility but below the limit for tax credits that would help them buy insurance through the private marketplace.

Clearly, we need to find and implement policy solutions for people in the coverage gap and others who cannot afford health insurance.

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