IMPORTANT INFORMATION ABOUT HEALTHCARE

The Affordable Care Act (ACA) sought to address the gaps in our health care system that leave millions of people without health insurance by extending Medicaid coverage to many low-income individuals and providing subsidies for Marketplace coverage for individuals below 400% of poverty. Following the ACA, the number of uninsured nonelderly Americans declined by 20 million, dropping to an historic low in 2016. However, beginning in 2017, the number of uninsured nonelderly Americans increased for three straight years, growing by 2.2 million from 26.7 million in 2016 to 28.9 million in 2019, and the uninsured rate increased from 10.0% in 2016 to 10.9% in 2019.

New research has focused on an aspect of the ACA/health care debate that hasn’t really been discussed—the social impact on communities. The author of a new report was able to control for income level and other factors and still finds issues with trust, support and other issues in communities where members are uninsured. A new study shows that access to health insurance can help hold a community together socially, and lack of it can contribute to the fraying of neighborhood cohesion.

The study, "Beyond Health Effects? Examining the Social Consequences of Community Levels of Uninsurance Pre-ACA," published by the Journal of Health and Social Behavior, is an effort by researchers Tara McKay and Stefan Timmermans to "broaden the conversation" about the effects of the Affordable Care Act (ACA).

"Given the strain that uninsurance places on individuals, providers and health care markets, it is not unreasonable to imagine that the consequences of uninsurance are likely to go beyond health and health care and impact the social lives of individuals and communities," said McKay, assistant professor of Medicine, Health and Society at Vanderbilt University.

How many people are uninsured?
For the third year in a row, the number of uninsured increased in 2019. In 2019, 28.9 million nonelderly individuals were uninsured, an increase of more than one million from 2018. Coverage losses were driven by declines in Medicaid and non-group coverage and were particularly large among Hispanic people and for children. Despite these recent increases, the uninsured rate in 2019 was substantially lower than it was in 2010, when the first ACA provisions went into effect and prior to the full implementation of Medicaid expansion and the establishment of Health Insurance Marketplaces.

Who are the uninsured?
Most uninsured people have at least one worker in the family. Families with low incomes are more likely to be uninsured. Reflecting the more limited availability of public coverage in some states, adults are more likely to be uninsured than children. People of color are at higher risk of being uninsured than non-Hispanic White people.

Why are people uninsured?
Even under the ACA, many uninsured people cite the high cost of insurance as the main reason they lack coverage. In 2019, 73.7% of uninsured adults said that they were uninsured because the cost of coverage was too high. Many people do not have access to coverage through a job, and some people, particularly poor adults in states that did not expand Medicaid, remain ineligible for financial assistance for coverage. Additionally, undocumented immigrants are ineligible for Medicaid or Marketplace coverage.

How does not having coverage affect health care access?
People without insurance coverage have worse access to care than people who are insured. Three in ten uninsured adults in 2019 went without needed medical care due to cost. Studies repeatedly demonstrate that uninsured people are less likely than those with insurance to receive preventive care and services for major health conditions and chronic diseases.

What are the financial implications of being uninsured?
The uninsured often face unaffordable medical bills when they do seek care. In 2019, uninsured nonelderly adults were over twice as likely as those with private coverage to have had problems paying medical bills in the past 12 months. These bills can quickly translate into medical debt since most of the uninsured have low or moderate incomes and have little, if any, savings.