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The Uninsured: A Primer - Key Facts about Health Insurance and the Uninsured in the Era of Health Reform

Millions of people in the United States go without health insurance each year. Because nearly all of the elderly are insured by Medicare, most uninsured Americans are nonelderly (under age 65). A majority of the nonelderly receive their health insurance as a job benefit, but not everyone has access to or can afford this type of coverage. The Affordable Care Act (ACA), which was passed in 2010, aimed to expand coverage by providing for an expansion of Medicaid for adults with incomes at or below 138% of poverty, building on employer-based coverage, and providing premium tax credits to make private insurance more affordable for many with incomes between 100-400% of poverty.1 Most of the major coverage provisions of the ACA went into effect in 2014, and millions of people have gained coverage under the law. However, many continue to lack coverage for a variety of reasons. For example, Medicaid eligibility for adults remains limited in states that have not adopted the expansion, some people remain ineligible for financial assistance for private coverage, and some still find coverage unaffordable even with financial assistance.

The gaps in our health insurance system affect people of all ages, races and ethnicities, and income levels; however, those with the lowest incomes face the greatest risk of being uninsured. Being uninsured affects people’s access to needed medical care and their financial security. The access barriers facing uninsured people mean they are less likely to receive preventive care, are more likely to be hospitalized for conditions that could have been prevented, and are more likely to die in the hospital than those with insurance. The financial impact also can be severe. Uninsured families struggle financially to meet basic needs, and medical bills can quickly lead to medical debt.

The Uninsured: A Primer provides information on how insurance changed under the ACA, how many people remain uninsured, who they are, and why they lack health coverage. It also summarizes what we know about the impact lack of insurance can have on health outcomes and personal finances and the difference health insurance makes in people’s lives.

What was happening to insurance coverage leading up to the ACA?

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Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in Menlo Park, California.