What does health insurance coverage look like for Americans today, more than eight years after the Affordable Care Act's passage? In this brief, we present findings from the Commonwealth Fund's latest Biennial Health Insurance Survey to assess the extent and quality of coverage for U.S. working-age adults. Conducted since 2001, the survey uses three measures to gauge the adequacy of people's coverage: (1) whether or not they have insurance, (2) if they have insurance, whether they have experienced a gap in their coverage in the prior year, (3) whether high out-of-pocket health care costs and deductibles are causing them to be underinsured, despite having continuous coverage throughout the year. As the findings highlighted below show, the greatest deterioration in the quality and comprehensiveness of coverage has occurred among people in employer plans. More than half of Americans under age 65--about 158 million people--get their health insurance through an employer, while about one-quarter either have a plan purchased through the individual insurance market or are enrolled in Medicaid. Although the ACA has expanded and improved coverage options for people without access to a job-based health plan, the law largely left the employer market alone. Survey Highlights. (1) Today, 45 percent of U.S. adults ages 19 to 64 are inadequately insured--nearly the same as in 2010--though important shifts have taken place. (2) Compared to 2010, many fewer adults are uninsured today, and the duration of coverage gaps people experience has shortened significantly. (3) Despite actions by the Trump administration and Congress to weaken the ACA, the adult uninsured rate was 12.4 percent in 2018 in this survey, statistically unchanged from the last time we fielded the survey in 2016. (4) More people who have coverage are underinsured now than in 2010, with the greatest increase occurring among those in employer plans. (5) People who are underinsured or spend any time uninsured report cost-related problems getting care and difficulty paying medical bills at higher rates than those with continuous, adequate coverage. (6) Federal and state governments could enact policies to extend the ACA's health coverage gains and improve the cost protection provided by individual-market and employer plans. The 2018 Commonwealth Fund Biennial Heath Insurance Survey included a nationally representative sample of 4,225 adults ages 19 to 64. SSRS conducted the telephone survey between June 27 and November 11, 2018.
Copyright:
Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY license. (More information)