1. How the Affordable Care Act Has Improved Americans’ Ability to Buy Health Insurance on Their Own
Findings from the Commonwealth Fund Biennial Health Insurance Survey, 2016
Sara R. Collins, Ph.D.
Vice President, Health Care Coverage and Access
The Commonwealth Fund
Media Teleconference
January 31, 2017

2. Summary of Major Findings
Exhibit 1
Summary of Major Findings
There were significant improvements in people’s ability to buy health plans on their own after implementation of the ACA insurance reforms.
Among working age adults who tried to buy individual coverage, the percentage who said it was very difficult to find an affordable plan fell by almost half between 2010 and 2016.
Uninsured rates among lower income adults have fallen by 17 percentage points since 2010 and are more than 10 percentage points below 2001 levels.
More Americans are getting the health care they need: adults who reported not getting needed health care because of costs fell from a high of 80 million in 2012 to an estimated 63 million in 2016.
There have been modest improvements in people’s reports of problems paying their medical bills.

3. Exhibit 2
The ACA’s Individual Market Reforms and Subsidies Have Made It Easier for People to Buy Health Plans on Their Own
Total
Health problem**
2010
2016
Adults ages 19–64 with individual coverage* or who tried to buy it in past three years who:
26 million
44 million
Found it very difficult or impossible to find affordable coverage
60%
34%
70%
42%
Found it very difficult or impossible to find coverage they needed
43%
25%
53%
31%
Has individual coverage* or ended up buying a health insurance plan^
46%
12 million
66%
29 million
36%
Note: FPL refers to federal poverty level. * Bought in the past three years. ** Respondent rated their health status as fair or poor, or has any of the following chronic conditions: hypertension or high blood pressure; heart disease, including heart attack; diabetes; asthma, emphysema, or lung disease; high cholesterol. ^ Among those who ever tried buying health insurance on their own in the past three years.
Data: The Commonwealth Fund Biennial Health Insurance Surveys (2010 and 2016). 3

4. Exhibit 3
The Number of Uninsured Adults Dropped to 23 Million in 2016, Down from 37 Million in 2010
Adults ages 19–64
2001
2003
2005
2010
2012
2014
2016
Uninsured now
15%
24 million
17%
30 million
18%
32 million
20%
37 million
19%
36 million
16%
29 million
12%
23 million
Insured now, had a gap 9%
15 million
16 million 8%
10%
19 million
13%
18 million
Continuously insured
76%
123 million
74%
127 million
72%
125 million
132 million
70%
129 million
131 million
78%
147 million
Notes: “Uninsured now” refers to adults who reported being uninsured at the time of the survey; “Insured now, had a gap” refers to adults who were insured at the time of the survey but were uninsured at any point during the year before the survey field date; “Continuously insured” refers to adults who were insured for the full year up to and on the survey field date.
Data: The Commonwealth Fund Biennial Health Insurance Surveys (2001, 2003, 2005, 2010, 2012, 2014, 2016).

5. Exhibit 4
People with Family Incomes Less Than $48,500 Have Uninsured Rates More than 10 Percentage Points Below 2001 Levels
Percent of adults ages 19–64 who are uninsured and earn less than 200% FPL
Notes: FPL refers to federal poverty level. Income levels are for a family of four in Rates are for those uninsured at the time of the survey.
Data: The Commonwealth Fund Biennial Health Insurance Surveys (2001, 2010, 2012, 2014, 2016).

6. Exhibit 5
Young Adults Have Made the Greatest Gains in Coverage of Any Age Group Since 2010
Percent of adults ages 19–64 who are uninsured
Data: The Commonwealth Fund Biennial Health Insurance Surveys (2001, 2003, 2005, 2010, 2012, 2014, 2016).

7. Fewer Adults Report Not Getting Needed Care Because of Cost
Exhibit 6
Fewer Adults Report Not Getting Needed Care Because of Cost
2003
2005
2010
2012
2014
2016
Percent of adults ages 19–64 who reported any of the following cost- related access problems in the past year:
Had a medical problem but did not visit doctor or clinic
Did not fill a prescription
Skipped recommended test, treatment, or follow-up
Did not get needed specialist care
37%
63 million
64 million
41%
75 million
43%
80 million
36%
66 million
34%
Data: The Commonwealth Fund Biennial Health Insurance Surveys (2003, 2005, 2010, 2012, 2014, 2016).

8. Exhibit 7
Uninsured Adults and Those with Coverage Gaps Reported Cost-Related Access Problems at Higher Rates Than Did Those Continuously Insured
Percent of adults ages 19–64 who had any of four access problems in past year because of cost*
Notes: * Includes any of the following because of cost: did not fill a prescription; did not see a specialist when needed; skipped recommended medical test, treatment, or follow-up; had a medical problem but did not visit doctor or clinic. “Continuously insured” refers to adults who were insured for the full year up to and on the survey field date; “Insured now, had a gap” refers to adults who were insured at the time of the survey but were uninsured at any point during the year before the survey field date; “Uninsured now” refers to adults who reported being uninsured at the time of the survey.
Data: The Commonwealth Fund Biennial Health Insurance Surveys (2012 and 2016).

9. Fewer Adults Reported Medical Bill Problems in 2016 Than in 2012
Exhibit 8
Fewer Adults Reported Medical Bill Problems in 2016 Than in 2012
2005
2010
2012
2014
2016
Percent of adults ages 19–64 who reported any of following bill or medical debt problems in the past year:
Had problems paying or unable to pay medical bills
Contacted by a collection agency for unpaid medical bills
Had to change way of life to pay bills
Medical bills/debt being paid off over time
34%
58 million
40%
73 million
41%
75 million
35%
64 million
37%
70 million
Data: The Commonwealth Fund Biennial Health Insurance Surveys (2005, 2010, 2012, 2014, 2016).

10. Exhibit 9
Uninsured Adults and Those with Coverage Gaps Reported Medical Bill Problems at Higher Rates Than Did Those Continuously Insured, 2016
Percent of adults ages 19–64 who had medical bill problems or accrued medical debt*
Uninsured now or had a gap**
Notes: * Includes any of the following: had problems paying medical bills, contacted by a collection agency for unpaid bills, had to change way of life in order to pay medical bills, or has outstanding medical debt. ** Sample size too small to break out by “Insured now, had a gap” and “Uninsured now”. “Continuously insured” refers to adults who were insured for the full year up to and on the survey field date; “Insured now, had a gap” refers to adults who were insured at the time of the survey but were uninsured at any point during the year before the survey field date; “Uninsured now” refers to adults who reported being uninsured at the time of the survey; "Uninsured now or had a gap" refers to adults who were uninsured at any point during the year before the survey field date or on the survey field date. FPL refers to federal poverty level. Income levels are for a family of four in 2015.
Data: The Commonwealth Fund Biennial Health Insurance Survey (2016).

11. Exhibit 10
Uninsured Adults Are Less Likely to Have a Regular Source of Care or Receive Preventive Care, 2016
Percent of adults ages 19–64
Notes: “Continuously insured” refers to adults who were insured for the full year up to and on the survey field date; “Insured now, had a gap” refers to adults who were insured at the time of the survey but were uninsured at any point during the year before the survey field date; “Uninsured now” refers to adults who reported being uninsured at the time of the survey. Respondents were asked if they: had their blood pressure checked within the past two years (in past year if has hypertension or high blood pressure); had their cholesterol checked in past five years (in past year if has hypertension, heart disease, or high cholesterol); and had their seasonal flu shot within the past 12 months.
Data: The Commonwealth Fund Biennial Health Insurance Survey (2016).

12. Uninsured Adults Are Less Likely to Receive Cancer Screenings, 2016
Exhibit 11
Uninsured Adults Are Less Likely to Receive Cancer Screenings, 2016
Percent of adults ages 19–64
Notes: “Continuously insured” refers to adults who were insured for the full year up to and on the survey field date; “Insured now, had a gap” refers to adults who were insured at the time of the survey but were uninsured at any point during the year before the survey field date; “Uninsured now” refers to adults who reported being uninsured at the time of the survey. Respondents were asked if they: received a Pap test within the past three years for females ages 21–64, received a mammogram within the past two years for females ages 40–64, and received a colon cancer screening within the past five years for adults ages 50–64.
Data: The Commonwealth Fund Biennial Health Insurance Survey (2016).

13. Conclusions and Policy Implications
Exhibit 12
Conclusions and Policy Implications
The ACA has significantly lowered uninsured rates for US adults of all races, ages and income groups.
These gains are enabling more people to get the health care they need.
Insured Americans are more likely to go to the doctor when sick, or get preventive care and cancer screenings than those without coverage.
ACA subsidies and market reforms have led to a significant improvement in the ability of adults to buy health insurance on their own.
Weaknesses in coverage remain including ongoing problems buying individual insurance; high rates of medical bill problems.
Repeal of key ACA provisions like subsidies without an effective replacement will exacerbate these weaknesses and leave problems in insurance unrelated to the ACA unaddressed.

14. Survey Methodology Exhibit 13
Respondents completed 25-minute telephone interviews in English or Spanish conducted by Princeton Survey Research Associates International (PSRAI) from July 12 to November 20, 2016.
Study includes a nationally representative sample of 6,005 adults ages 19 and older living in the continental United States.
The report analysis is limited to adults ages 19 to 64 (n=4,186).
A combination of landline and cell phone random-digit dial (RDD) samples was used to reach respondents.
Statistical results are weighted to correct for the stratified sample design, overlapping landline and cellular phone sample frames, and disproportionate non-response that might bias results. The data are weighted to the U.S. adult population by age, sex, race/ethnicity, education, household size, geographic region, population density, and household telephone use, using the U.S. Census Bureau’s 2016 Annual Social and Economic Supplement.
Overall margin of sampling error of +/– 1.9 percentage points at the 95 percent confidence level.
Study also reports estimates from 2001, 2003, 2005, 2010, 2012, and 2014 Commonwealth Fund Biennial Health Insurance Surveys, also conducted by PSRAI.