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Melissa Blair
Robert Wood Johnson Foundation
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Uninsurance Rates and the Affordable Care Act

A new policy brief from Health Affairs and the Robert Wood Johnson Foundation considers how uninsurance rates are changing under the Affordable Care Act (ACA), which was implemented to decrease the number of Americans lacking health insurance. Four government surveys (and a few private surveys) have been conducted to measure what is understandably the most important metric in evaluating the ACA's effect. The brief details the challenges encountered in measuring the ACA's success in this area.

Topics covered by this policy brief include: 

  • What's the background? This section of the brief details the government surveys and their methodology. The surveys discussed are the Current Population Survey (CPS); the National Health Interview Survey (NHIS); the American Community Survey (ACS); and the Medical Expenditure Panel Survey (MEPS). Exhibit 1 shows the 2014 uninsurance rates for all four surveys; the rates range from 13.3 percent to 18.3 percent. In addition, The Commonwealth Fund and the RAND Corporation also provide uninsurance data, as do the Gallup-Healthways Well-Being Index and the Health Reform Monitoring Survey (HRMS) -- which are explained in the brief.

  • What's in the law and what's the debate? As the brief outlines, there are several provisions in the ACA aimed at lowering uninsurance. The brief reviews the following major ACA provisions: allowing young adults to remain on their parents' health plans until age twenty-six; the expansion of Medicaid; and the establishment of state Marketplaces. The debates over measuring uninsurance, the brief suggests, are based on the question of how to extrapolate uninsurance rates from the large number of people in a sample who do not respond to a survey. Overall, the brief reports, the uninsurance rate for young adults ages 19-25 declined from more than 30 percent in 2009 to 19 percent in 2014. For adults ages 18-64, the states with the largest percentage-point decline in uninsurance from 2013 to 2014 all expanded their Medicaid programs.

  • What's next? While uninsurance has declined significantly since the ACA was implemented, it remains to be seen whether this trend will continue in the coming years. Many of those remaining uninsured, the brief notes, might be hard to enroll because of their immigration status or because they live in states that have not chosen to expand Medicaid.

About Health Policy Briefs

Health Policy Briefs are aimed at policy makers, congressional staffers, and others needing short, jargon-free explanations of health policy basics. The briefs, which are reviewed by experts in the field, include competing arguments on policy proposals and the relevant research supporting each perspective.

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About Health Affairs

Health Affairs is the leading journal at the intersection of health, health care, and policy. Published by Project HOPE, the peer-reviewed journal appears each month in print and online, with additional Web First papers and health policy briefs published regularly at Read daily perspectives on Health Affairs Blog and customize the content you want to see in Health Affairs Alerts.

About the Robert Wood Johnson Foundation

For more than 40 years the Robert Wood Johnson Foundation has worked to improve health and health care. We are striving to build a national Culture of Health that will enable all to live longer, healthier lives now and for generations to come. For more information, visit Follow the Foundation on Twitter at or on Facebook at