Uninsured working-age adults in the United States are disproportionately low-income, Latinx, and young, with affordability of coverage a key factor in their being uninsured, a report from the Commonwealth Fund finds.
Based on the 2018 Commonwealth Fund Biennial Health Insurance Survey, the brief, Who Are the Remaining Uninsured, and Why Do They Lack Coverage? (HTML or PDF, 15 pages), found that an estimated 30.4 million people between the ages of 19 and 64 were uninsured in 2018 — 18.2 million fewer than when the Affordable Care Act first went into effect but up from a low of 28.6 million in 2016. More than half (58 percent) of the uninsured had incomes below 200 percent of the federal poverty level ($24,120 for an individual and $49,200 for a family of four), while 44 percent were under the age of 35. Latinx adults, who make up 18 percent of the U.S. working-age population, accounted for 35 percent of the uninsured, including 25 percent who were foreign-born.
The report also found that while 47 percent of the uninsured in 2018 could have been eligible, based on their income, for expanded Medicaid or subsidized insurance plans, a significant majority (67 percent) of those individuals chose not to explore their options in the marketplace. Their reasons for not doing so were that they could not afford it (36 percent), did not think they needed it (15 percent), did not think they were eligible (8 percent), or were not aware of the health insurance marketplace (7 percent). Among those who previously had insurance but lost coverage in 2018, 34 percent said they couldn't afford their plan's cost, with the percentage of people saying they had difficulty finding affordable coverage in the individual market rising to 42 percent in 2018, from 34 percent in 2016. According to the report, the percentage of people with health problems and with incomes both below and above 200 percent of the poverty level who could not find affordable coverage all dropped significantly between 2010 and 2016 but increased again in 2018.
Given that affordability is a key reason more than thirty million working-age adults remain uninsured, the report's authors call for expanding Medicaid in all states — and without restrictions such as work requirements; lifting the income cap on eligibility for marketplace tax credits; reinstating funding for outreach and navigator services and extending the open-enrollment period; banning or limiting short-term and other plans that don't comply with the Affordable Care Act; making premium payments for individual market plans fully tax-deductible; better informing people about their options; and reducing Medicaid churn by streamlining enrollment and enrollment processes.