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New report looks at demographics of America’s uninsured


NEW YORK — A new report from the Commonwealth Fund is shedding light on who makes up the estimated 24 million adults between 19 and 64 years of age six years after the Affordable Care Act was first implemented. The report notes that though the overall numbers of uninsured people has dwindled since the ACA took effect, Latinos make up a growing share of those still left uninsured, as do residents of states that opted out of the ACA’s Medicaid expansion.  


“About 26 million Americans have gained coverage through the Affordable Care Act’s marketplaces and Medicaid expansion,” said Sara Collins, Vice President for Health Care Coverage and Access at The Commonwealth Fund and the report’s lead author. “However, millions of people still don’t have health insurance. That means they are likely to go without the health care they need and are at risk of medical debt or bankruptcy if they get sick.”


According to the report, in 2013, 50% of the uninsured were white, 29% were Latino, 13% were black and 6% identified with another demographic group. In early 2016, 41% of the uninsured were white, and 12% were black, but 40% were Latino, with 6% of other groups uninsured. 


Among the primary reasons the Commonwealth Fund cites for the large share of uninsured Latino individuals is the exclusion of undocumented immigrants in the ACA. The proportion of Latino people among uninsured adults is 47%, with 46% of them working for small businesses. 


One of the biggest factors that made a difference in uninsured rates among both Latino and black individuals has been expanded Medicaid eligibility. In the 30 states and the District of Columbia, all of which have opted into the Medicaid expansion, only 7%-9% of white, black and American-born Latino residents are uninsured. In states that do not have the expansion, 10% of the uninsured are white, 16% are black, and 24% are American-born Latinos. 


The report notes that a third of the remaining uninsured adults who would likely be eligible for expanded Medicaid — some 4 million people — live in the 20 states that did not expand Medicaid eligibility as of April 2016 (Louisiana expanded eligibility this year, but enrollment did not begin until June). But even those who would qualify for Medicaid or plan subsidies are concerned they wouldn’t be able to afford marketplace coverage, with 64% of uninsured adults surveyed by the Commonwealth Fund saying they hadn’t shopped for coverage because they didn’t expect to be able to afford it. Some 85% of those who did shop for coverage said they couldn’t find an affordable plan. 


The studies authors noted that potential ways to increase the amount of insured people in the United States include expanding Medicaid eligibility in states that have not yet done so, enhancing subsidies and lower cost-sharing in marketplace plans, immigration reform, changing eligibility for undocumented immigrants under the ACA and more efforts to reach the uninsured to help with the enrollment process. 


“The Affordable Care Act 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 Dr. David Blumenthal said. “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.”


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