No abstract

To learn more about new publications when they become available, visit the Fund' s website and register to receive email alerts.

Issue: Since 2001, long before the passage of the Affordable Care Act (ACA), the Commonwealth Fund Biennial Health Insurance Survey has examined health coverage and consumers' experiences buying insurance and using health care. Goals: To examine long-term trends and to make comparisons before and after passage of health reform. Methods: Analysis of the Commonwealth Fund Biennial Health Insurance Survey, 2016. Findings and Conclusions: There have been dramatic improvements in people' s ability to buy health plans on their own following the passage of the ACA. For adults with family incomes less than $48,500, uninsured rates dropped about 17 percentage points below their 2010 peak. Lower-income whites, blacks, and Latinos have experienced drops this large, though Latinos are uninsured at higher rates. Among working-age adults who had shopped for plans in the individual market and ACA marketplaces over the prior three years, the percentage who reported it was very difficult to find affordable plans fell by nearly half from 2010, prior to the ACA reforms, to 2016. Coverage gains are helping working-age Americans get the care they need: the number of adults who reported problems getting needed health care and filling prescriptions because of costs fell from a high of 80 million in 2012 to an estimated 63 million in 2016. BACKGROUNDPrior to the passage of the Affordable Care Act, the individual insurance market was a notoriously difficult place for consumers without employer-based health benefits to purchase insurance. It also was challenging for insurers to sell insurance without incurring large losses. As a result, insurers went to great lengths to exclude people with even mild health problems. In 2010, the Commonwealth Fund Biennial Health Insurance Survey found that more than one-third of people who tried to purchase health insurance in the individual market in the previous three years-an estimated 9 million people-had been turned down, charged a higher price, or had a condition excluded from their health plan. 1To learn more about new publications when they become available, visit the Fund' s website and register to receive email alerts.

To learn more about new publications when they become available, visit the Fund' s website and register to receive email alerts.

Across the country's four largest states, uninsured rates vary for adults ages 19 to 64: 12 percent of New Yorkers, 17 percent of Californians, 21 percent of Floridians, and 30 percent of Texans lacked health coverage in 2014. Differences also extend to the proportion of residents reporting problems getting needed care because of cost, which was significantly lower in New York and California compared with Florida and Texas. Similarly, lower percentages of New Yorkers and Californians reported having a medical bill problem in the past 12 months or having accrued medical debt compared with Floridians and Texans. These differences stem from a variety of factors, including whether states have expanded eligibility for Medicaid, the state's uninsured rate prior to the Affordable Care Act taking effect, differences in the cost protections provided by private health insurance, and demographics. OVERVIEWThe Affordable Care Act has had profound implications for health insurance coverage in the United States. More than 25 million Americans now have coverage under its provisions, which include the expansion of Medicaid eligibility, subsidized private plans purchased in the health insurance marketplaces, and-for young adults up to age 26-the opportunity to enroll in a parent's plan. 1 A recent analysis of the Commonwealth Fund Biennial Health Insurance Survey indicates that the percentage of uninsured adults has dropped from 20 percent in 2010 to 16 percent in 2014. 2 The law, however, gives states flexibility in implementing its provisions, including the choice of operating their own health insurance marketplace or leaving that task to the federal government. Moreover, in 2012, the U.S. Supreme Court gave states the power to decide whether or not to expand Medicaid eligibility to more lower-income adults. States' policy choices, combined with each state's unique demographic characteristics and history, have resulted in a wide range of experiences among Americans since the law took effect. In this brief we use data from the Biennial Survey to examine differences in health insurance coverage, cost-related problems getting needed care, and medical bill problems and debt among adults ages 19 to 64 in the nation's four largest states.The four largest states in the U.S.-California, Florida, New York, and Texas-fall into two distinct categories. The first group is represented by CaliforniaTo learn more about new publications when they become available, visit the Fund' s website and register to receive email alerts.