Who Are the Remaining Uninsured and Why Haven't They Gotten Covered?

Despite coverage gains since the implementation of the Affordable Care Act, groups at risk of being uninsured before the law continue to have higher uninsured rates.

Since the implementation of the Affordable Care Act (ACA), adults most at risk of being uninsured have made the greatest gains in coverage. However, despite these coverage gains, each of the groups most at risk of being uninsured before the ACA continues to have higher uninsured rates than their demographic counterparts, according to a new report from the Commonwealth Fund.

Latinos and people with low incomes are most likely to remain uninsured despite the enactment of the ACA. The report states that of the US adult population currently without health insurance, 88% is Latino, earns under $16,243 per year, is under age 35, and/or works for a small business. Half of the remaining uninsured live in one of the 20 states that has not expanded Medicaid at the time the survey was conducted.

Approximately 24 million working-age adults were not insured between February and April 2016, 6 years after the implementation of the ACA. Although the number of people without health insurance fell by 20 million since the ACA came into effect, the composition of the uninsured population has changed, with white adults now making up a smaller share and Latinos a larger share. The report suggests that one reason Latinos remain uninsured is that the ACA excludes undocumented immigrants. Latinos also comprise a significant portion of other groups at high risk for not having coverage: among uninsured adults earning less than 138% of the federal poverty level, 47% are Latino. Latinos also make up 47% of uninsured young adults and 46% of uninsured adults working for small businesses.

The report lists other reasons cited by survey respondents to explain being uninsured: they are worried about affording marketplace coverage even if they are qualified for subsidies, and the uninsured are less aware of the marketplaces and how they work (62% of uninsured survey respondents were aware of the marketplaces versus 79% of all adults).

“The ACA was designed to help the United States achieve coverage for all Americans and ensure that everyone can get the health care they need,” Commonwealth Fund President David Blumenthal, MD, said in a statement. “The law has been successful in reducing the number of uninsured, but now it is time to make it possible for all to realize its benefits.”

The report suggests the following additional actions to ensure that everyone in the nation receives the full benefit of the ACA:

  • States could expand eligibility for their Medicaid programs
  • Broad immigration reform would help increase the numbers of people eligible for coverage under the ACA
  • More efforts to reach the uninsured and help them with the enrollment process
  • Enhanced subsidies and lower cost-sharing in marketplace plans may be needed

The survey was conducted between February and April 2016. It consisted of 15-minute phone interviews in English or Spanish, and was conducted among a random, nationally representative sample of 4802 adults, ages 19 to 64, living in the United States. Interviews were done on landline and cellular phones.