ACA's First Year

More Are Getting, and Affording Needed Health Care

For the first time, uninsured rates plummet,
particularly Among young & low income

New research from The Commonwealth Fund

New York, NY, January 15, 2015—The number of Americans reporting they did not receive needed health care because of its cost dropped for the first time since 2003, falling from 80 million in 2012 to 66 million, according to The Commonwealth Fund’s 2014 Biennial Health Insurance Survey.

And the number saying they had trouble paying their medical bills or were paying off medical debt fell from 75 million in 2012 to 64 million—the first time it declined since this question was initially asked in 2005. The survey, discussed in the new brief, The Rise in Health Care Coverage and Affordability Since Health Reform Took Effect, was fielded between July and December 2014 and asked respondents about their health insurance status, access to health care, and medical bill problems and debt over the previous 12 months. It found improvements on nearly every measure, including the percentages of adults who reported that, because of the cost, they:

  • did not visit a doctor or clinic when they had a medical problem, which fell from 29 percent in 2012 to 23 percent in 2014;
  • did not fill a prescription, which fell from 27 percent to 19 percent;
  • skipped a recommended test, treatment, or follow-up visit, which declined from 27 percent to 19 percent; and
  • did not see a specialist, which dropped from 20 percent to 13 percent.

In addition, the share of adults who said they had trouble paying their medical bills, or could not pay them at all, fell from 30 percent in 2012 to 23 percent in 2014; the percentage who had been contacted by a collections agency about unpaid medical bills fell from 18 percent to 15 percent; and the rate of adults paying off medical debt over time fell from 26 percent to 22 percent.

“These declines are remarkable and unprecedented in the survey’s more than decade-long history,” said Sara Collins, vice president for Health Care Coverage and Access at The Commonwealth Fund and the study’s lead author. “They indicate that the Affordable Care Act is beginning to help people afford the health care they need. We also found sharp declines in the uninsured rate nationwide. Unfortunately, we’re still seeing high uninsured rates in states that haven’t expanded Medicaid.”

According to the report, the number of uninsured working-age Americans fell from 37 million, or 20 percent, in 2010 to 29 million, or 16 percent, in 2014. The largest declines were among people who were the most likely to have been uninsured in the past—young adults and individuals with low incomes. The uninsured rate for young adults ages 19 to 34 fell from 27 percent in 2010 to 19 percent in 2014. Among adults with incomes below 200 percent of the federal poverty level ($22,980 for an individual and $47,100 for a family of four), the uninsured rate dropped from 36 percent in 2010 to 24 percent in 2014—the lowest rate for people in this income range since the Commonwealth Fund survey was first fielded in 2001.

the Affordable Care Act is beginning to help people afford the health care they need

In states that have not expanded eligibility for Medicaid, however, uninsured rates among people with low incomes are still high: more than one-third (35%) of adults with incomes below the poverty level ($11,490 for an individual and $23,550 for a family of four) remained uninsured in 2014 in the 24 states that had not expanded Medicaid and started enrolling people by July 2014, when the survey was fielded. In contrast, only about one-fifth (19%) of low-income adults were uninsured in states that did expand Medicaid. Sixty-one percent of the remaining 29 million people without health insurance live in states that have not expanded Medicaid.

Uninsured and Insured Low-Income Adults Still Struggle to Afford Health Care

People without health insurance, including those with low incomes in states not expanding Medicaid, are still often finding health care costs beyond their reach. According to the report, nearly three of five (57%) adults who were uninsured during the year went without care because of the cost in the past year and half (51%) reported medical bill problems or debt.

Among those who were insured all year, people with lower incomes were the most likely to report affordability problems. According to the survey, 34 percent of insured adults making less than about $23,000 a year had trouble paying their medical bills or were paying off medical debt over time, and 33 percent reported they had not gotten needed health care because of the cost.

“Getting millions of Americans good, secure health insurance is essential to improving people’s health and helping our health care system work smarter,” said Commonwealth Fund President David Blumenthal, M.D. “These significant improvements in people’s ability to get and afford care should continue as more people gain health insurance. At the same time, our surveys will continue to track whether increasing cost-sharing requirements are placing significant burdens on families.”

Additional Survey Findings

  • Non-Hispanic whites, Latinos, and African Americans see similar declines in uninsured rates. Although uninsured rates declined among African Americans and Latinos, whites are still much more likely to have health insurance. The uninsured rate for whites fell from 15 percent in 2010 to 10 percent in 2014; among African Americans, it fell from 24 percent to 18 percent, and among Latinos, it fell from 39 percent to 34 percent.
  • Uninsured adults are less likely to have a regular doctor or to get preventive care. Seven of 10 (71%) adults who were uninsured during the year reported having a regular doctor or source of care, compared to 94 percent of those insured all year. Only 32 percent of uninsured adults ages 50 to 64 had a colon cancer screening in the past five years, compared to 61 percent of adults with health insurance. Among women, 49 percent of uninsured women ages 40 to 64 had a mammogram in the past two years, compared to about three-quarters of women with coverage.