Key Facts about the Uninsured Population

Transcript

1 Key Facts about the Uninsured Population Medicaid The Affordable Care Act (ACA) led to historic gains in health insurance coverage by extending low providing Marketplace subsidies for individuals below 400% of - coverage to many income individuals and Under the law, the number of uninsured nonelderly Americans decreased from 44 million in 2013 (the poverty. ) to less than 28 million as of the end of 2016. Recent year before the major coverage provisions went into effect efforts to alter the ACA or fundamentally change the structure of Medicaid may pose a challenge to further act sheet reducing the number of uninsured and may threaten coverage gains seen in recent years. This f coverage has changed under how describes the ACA, examines the characteristics of the uninsured population, and summarizes the access and financial implications of not having coverage. uninsured How has the number of under the ACA? changed In the past, gaps in the public insurance system and lack of access to affordable private coverage left millions without heal th Beginning in 2014, the ACA expanded coverage to millions of previously uninsured people through the expansion of insurance. caid and the establishment of Health Insurance Marketplaces. Data show substantial gains in public and private Medi insurance coverage and historic decreases in uninsured rates under the ACA . Coverage gains were particularly large among - income people living in states that expanded Medicaid. Still, millions of people low 27.6 million in 2016 — remain uninsured . — Why do people remain uninsured? Even under the ACA, many uninsured people cite the high cost of insurance as the main reason they lack coverage. In 2016 , 4 5 they remained uninsured because the cost of coverage was too high . Many people do not % of uninsured adults said that have access to coverage through a job, and some people, particularly poor adults in states that did not expand Medicaid, remain ineligibl financial assistance for coverage . Some people who are eligible for financial assistance under the ACA e for undocumented immigrants are ineligible for Medicaid or Marketplace coverage. may not know they can get help, and s Who remain uninsured? sured people are in low - Most unin Reflecting the more limited income families and have at least one worker in the family. availability of public coverage in some states, adults are more likely to be uninsured than children. People of color are at higher risk of bei ng uninsured than non - Hispanic Whites. How does the lack of insurance affect access to health care? People without insurance coverage have worse access to care than people who are insured. One in five uninsured adults in 2016 went without n eeded medical Studies repeatedly demonstrate that the uninsured are less likely than care due to cost. those with insurance to receive preventive care and services for major health conditions and chronic diseases. What are the financial implicat ions of lacking coverage? The uninsured often face unaffordable medical bills when they do seek care. In 2016, uninsured nonelderly adults were over twice as likely than their insured counterparts to have had problems paying medical bills in the past 12 months. These bi lls can quickly translate into medical debt since most of the uninsured have low or moderate incomes and have little, if any, savings .

2 In the past, gaps in the public insurance system and lack of access to affordable private coverage left millions without health insurance, and the number of uninsured Americans grew over time, particularly during periods of economic downturns. By 2013, more than 44 million people lacked coverage. Under the ACA, as of 2014, Medicaid coverage has been expanded to nearly all adults with incomes at or below 138% of poverty in states , and tax credits are available for people who p urchase coverage through a that have expand ed their programs h ealth insurance m arketplace. Millions of people have enrolled in these new coverage options, and the uninsured rate has dropped to a historic low. Coverage gains were particularly large among low - income adults living in states t — nonelderly individuals hat expanded Medicaid. Still, millions of people — 27.6 million in 2016 1 Figure 1 without coverage . remain Uninsured Rate Among the Nonelderly Population, 1998 - 2016 Key Details: 18.2 The share of the nonelderly population  that 16.7 16.6 16.6 16.4 16.1 was uninsured hovered around 16% between and 2007, then peaked during the 1998 10.3 ensuing economic recession (Figure 1). As early provisions of the ACA went into effect in 2010, and as the economy improved, the uninsured rate began to drop. When the major ACA coverage provisions went into effect in 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2014 , the uninsured rate dropped dramatically and continued to fall in subsequent years. In NOTES: Includes nonelderly individuals ages 0 - 64. SOURCE: Kaiser Family Foundation analysis of the 2016 National Health Interview Survey. nelderly uninsured rate was 2016, the no Figure 2 10.3 %, the lowest in decades. Percentage Point Change in Uninsured Rate among the 2016 - Nonelderly Population by Selected Characteristics, 2013 Coverage gains from 2013 to 2016 were  particularly large among groups targeted by Poverty Level Age Group Race/Ethnicity - the ACA, includ ing adults and poor and low Nonelderly 100 to 199% Adults Children <100% 200% > . The uninsured rate among income individuals 64 - 18 FPL FPL 0 FPL - 17 White Asian Hispanic Black nonelderly adults, who are more likely than - 1.4% children to be uninsured, dropped from 20.5% - 3.6% - 4.8% in 2013 to 12.2% in 2016 , a 40% decline . In addition, between 2013 and 2016, the - 7.3% 7.4% - 8.2% - e declined substantially for poor uninsured rat 9.5% - - onelderly individuals (Figure poor n and near 11.1% - - 11.3% . 2) People of color, who had higher uninsured 64. NOTES: Includes nonelderly individuals ages 0 - SOURCE: Kaiser Family Foundation analysis of the 2013 and 2016 National Health Interview Survey. Hispanic Whites prior to 2014, rates than non - Though uninsured rates dropped ac ross all states, they Hispanic Whites. non had larger coverage gains than - ropped more in states that chose to expand , decreasing by 7.1 percentage points compared to 3.7 Medicaid d 2 (See Appendix A for state - expansion states . points in non - by - state data on changes in the uninsured rate). Coverage gains were  seen in new ACA coverage options. As of February 2017, over 10 million people were 3 and as of June 2017, Medicaid enrollment had grown by over enrolled in state or federal Marketplace plans, 4 17 million (29%) since the period before open enrollment (which started in October 2013). 2 Key Facts about the Uninsured Population

3 Most of the nonelderly in the United States obtain health insurance through an employer, but not all workers red employer remiums. Medicaid are offe can afford their share of the p - sponsored coverage or, if offered, income individuals, and financial assistance for Marketplace coverage is available for many - cover s many low income people. However, Medicaid eligibility for adults remains limited in some states, and few moderate - people can afford to purc hase coverage without financial assistance. Some people who are eligible for coverage under the ACA may not know they can get help, and others may still find the cost of coverage prohibitive. Figure 3 Key Details: Reasons for Being Uninsured Among Uninsured Nonelderly Adults, 2016 or  C ost still poses a major barrier to coverage f Share who say they are uninsured because: the uninsured . In 2016, 45 % of uninsured nonelderly adults said they were uninsured Cost is too high 45% because the cost is too high , making it the Lost job or changed employers 23% most common reason cited for being Lost Medicaid 12% uninsured (Figure 3). Though financial Employer does not offer or ineligible for coverage 10% assistance is available to many of the Family status change 5 9% remaining un insured under the ACA, not No need for health coverage 2% everyone who is uninsured is eligible for free or subsidized coverage. In addition, some NOTES: Includes nonelderly adults ages 18 - 64. Respondents can select multiple reasons. Status change includes marital status uninsured who are eligible for help may not change, death of spouse or parent, or ineligible due to age or leaving school. SOURCE : Kaiser Family Foundation analysis of the 2016 National Health Interview Survey. be aware of coverage options or may face 6 tance was key to facilitating both initial and ongoing Outreach and enrollment assis barriers to enrollment. 7 enrollment in ACA coverage, but these programs face challenges due to funding cuts and high demand. s situation changes. In 2016, 23 % of uninsured nonelde rly Access to health coverage changes as a person’  adults said they were uninsured because the person who carried the health coverage in their family lost Nearly o ne in ten was uninsured because of a marital status their job or changed employers (Figure 3). %), and some due to age or leaving school (9 change, the death of a spouse or parent, or l oss of eligibility lost Medicaid because of a new job/increase in income or the plan stopping after pregnancy (12%).  As indicated above, n ot all workers have access to coverage through their job. nonelderly % of In 2016, 74 8 Moreover, nine un insured workers worked for an employer that did not offer health benefits to the worker. sponsored coverage report cost as out of ten uninsured workers who do not take up an offer of employer - 9 From 2006 to 2016, total premiums for family coverage the main reason for declining (90% increased by ) . 10 58%, and the worker’s share increased by 78%, outpacing wage growth.  As of income children, but eligibility for adults is more limited. Medicaid and CHIP are available for low - 11 had states the ACA . expanded Medicaid eligibility for adults under However, in January 2017 , 3 1 plus DC median eligibility level , with Medicaid, eligibility for adults remains limited ed expand have not states that 12 illion s adults wi thout dependent children ineligible in most cases just 44% of poverty and at for parents M . a of poor but not “coverage gap” because they earn too much to qualify for Medicaid in fall uninsured adults 13 enough to qualify for Marketplace premium tax credits. 14 Undocumented immigrants are in eligible for Medicaid or Marketplace coverage.  - present While lawfully immigrants under 400% of poverty are eligible for Marketplace tax credits, only those who have passed a fy for Medicaid. year waiting period after receiving qualified immigration status can quali - five Key Facts about the Uninsured Population 3

4 Most remaining uninsured people are in working families, are in families with low incomes , and are nonelderly 15 . are adults Reflecting income and the availability of public coverage, people who live in the South or West Most who remain uninsured have been without coverage for long periods of time. more likely to be uninsured . Figure 4 : Key Details Characteristics of the Nonelderly Uninsured, 2016  In 2016, three quarters of the uninsured (75%) had at least one full - time worker in their Asian/Native Family Income Family Work Status Race Hawaiian or - time family, and an additional 11% had a p art (%FPL) Other Pacific 3% Islander worker in their family (Figure 4). 5% No 400 %+ <100% 16 Workers FPL FPL  are at the highest Individuals below poverty 15% 11% 20% 24% Part - Time White Hispanic Workers risk of being uninsured. In total, eight in ten of 1 or More 44% 200 - 399% 33% Full - Time 100 - 199% FPL Workers FPL in families the uninsured with incomes were 31 % 25% 75% Black 15% in 2016 below 400% of poverty (Figure 4). While a plurality (44%) of the uninsured are  Total = 27.5 Million Nonelderly Uninsured non - Hispanic Whites, people of color are at NOTES: Includes nonelderly individuals ages 0 - 64. The U.S. Census Bureau's poverty threshold for a family with two adults and one higher risk of being uninsured than Whites. child was $ 19,318 in 2016. Data may not total 100% due to rounding. Persons of Hispanic origin may be of any race; all other race/ethnicity groups are non - Hispanic. SOURCE : Kaiser Family Foundation analysis of the March 2017 Current Population Survey, Annual Social and Economic Supplement. People of color make up 42% of the nonelderly Figure 5 U.S. population but account for over half of the Uninsured Rates Among the Nonelderly by State, 2016 population (Figure total nonelderly uninsured 4). Hispanics and Blacks have significantly WA ME VT MT ND NH higher uninsured rates (16.9% and 11.7%, MN MA OR NY WI SD ID RI MI 17 WY respectively) than Whites (7.6%). CT PA IA NJ NE OH DE IN IL NV MD  Most (85%) of the uninsured are nonelderly UT WV VA CO DC KS KY MO CA NC adults. The uninsured rate among children was TN SC OK AR AZ NM GA AL MS half the rate among just 5% in 2016, less than LA TX 18 nonelderly adults (12%), largely due to FL AK broader availability of Medicaid/CHIP for HI <7% (11 states including DC) children than for adults. 7 - 12% (28 states) >12% percent (12 states)  Most of the uninsured (78%) are U.S. citizens, NOTES: Includes nonelderly individuals ages 0 - 64. 19 SOURCE: Kaiser Family Foundation analysis of the March 2017 Current Population Survey, Annual Social and Economic Supplement. and 22% are non citizens. Uninsured non - - citizens include both lawfully present and undocumented immigrants. Undocumented immigrants are ineligible for federally funded health coverage , but legal immigrants can qualify for subsidies in the 20 Marketplaces and those who have been in the country for more than five years are eligible for M edicaid. the most likely to  Uninsured rates vary by state and by region, with individuals living in the South and West The eight out of the twelve states with the highest uninsured rates in 2016 were in the South . be uninsured (Figure 5 and Appendix A). , T his variation reflects different economic cond itions, state expansion status - er based coverage, and demographics . availability of employ  uninsured in 2016 have been without coverage for more than a Over two - thirds (67%) of the remaining 21 People who year. have been without coverage for long periods may be particularly hard to reach in outreach and enrollment efforts. 4 Key Facts about the Uninsured Population

5 Health insurance makes a difference in whether and when people get necessary medi cal care, where they get their care, and ultimately, how healthy they are. Uninsured adults are far more likely than those with insurance health care or forgo it altogether. The consequences can be severe, particularly when preventable to postpone ns or chronic diseases go undetected conditio . Figure 6 Key Details : Barriers to Health Care Among Nonelderly Adults by Insurance Status, 2016  Studies repeatedly demonstrate that the uninsured are less likely than those with 49% No Usual Source of Care 12% insurance to receive preventive care and 12% services for major health conditions and 23% Postponed Seeking Care Due to 23 , 22 9% One in five (20%) chronic diseases. Cost 6% Uninsured adults without coverage say that nonelderly 20% Medicaid /Other Public Went Without Needed Care they went without care in the past year 8% Due to Cost Employer/Other Private 3% because of cost compared to 3% of adults with 18% Postponed or did not get private coverage and 8% of adults with public needed prescription drug due 14% to cost 6% coverage. Part of the reason for poor access NOTE: Includes nonelderly adults ages 18 - 64. Includes barriers experienced in past 12 months. Respondents who said usual he uninsu red is that many among t (49 %) do source of care was the emergency room were included among those not having a usual source of care. All differences between uninsured and insurance groups are statistically significant (p < 0.05). SOURCE: Kaiser Family Foundation analysis of the 2016 National Health Interview Survey. not have a regular place to go when they are sick or need medical advice (Figure 6).  Because of the cost of care, many uninsured people do not obtain the treatments their health care providers recommend for them. In 2016, uninsur ed nonelderly adults were three times as likely as adults with private 24 coverage to say that they postponed or did not get a needed prescription drug due to cost (18% vs. 6%). And while insured and uninsured people who are injured or newly diagnosed with a chronic condition - up care, people without health coverage are less likely than those with receive similar plans for follow 25 coverage to obtain all the recommended services. to have regular outpatient  Because people without health coverage are less likely than those with insurance care, they are more likely to be hospitalized for avoidable health problems and to experience declines in their overall health. When they are hospitalized, uninsured people receive fewer diagnostic and therapeutic , 29 26 , 27 , 28 so have higher mortality rates than those with insurance. services and al  Research demonstrates that gaining health insurance improves access to health care considerably and diminishes the adverse effects of having been uninsured. A seminal study of a Medicaid expansion in Oregon found that uninsured adults who gained Medicaid coverage were more likely to receive care than their 30 counterparts who did not gain coverage. A comprehensive review of research on the effects of the ACA , services led to positive effects on access to care, utilization of exp finds that Medicaid expansion the ansion 31 . income population - among the low affordability of care, and financial security ged  Public hospitals, community clinics and health centers, and local providers that serve disadvanta communities provide a crucial health care safety net for uninsured people. However, safety net providers have limited resources and service capacity, and not all uninsured people have geographic access to a safety 32 , 33 net provider. 5 Key Facts about the Uninsured Population

6 The uninsured often face unaffordable medical bills when they do seek care. These bills can quickly translate 34 into medical debt since most of the uninsured have low or moderate incomes and have little, if any, savings. Figure 7 Key Details : Problems Paying Medical Bills by Insurance Status, 2016 Those without insurance for an entire year  35 of - - pay for one fifth of their care out - pocket. Uninsured Insured In addition, h ospitals frequently charge 76% uninsured patients much higher rates than 63% those paid by private health insurers an d 44% 37 , 36 public programs. 30% 29% 26% 24% Medical bills can put great strain on the  14% - uninsured and threaten their financial well Problems paying or Worried about being able Worried about paying Medical bills being paid In 2016, nonelderly uninsured adults being. unable to pay medical to pay costs for normal medical bills if get sick off over time bills care were over twice as likely as those with insurance to have problems paying medical NOTE: Includes nonelderly adults ages 18 - 64 . All differences between uninsured and insured groups are statistically significant (p < 0.05). SOURCE: Kaiser Family Foundation analysis of the 2016 National Health Interview Survey. ) with two thirds bills (29% vs. 14%; F igure 7 38 of uninsured who had medical bill problems unable to pay their medical bills at all (67%). Uninsured adults are also more likely to face negative consequences due to medical bills, such as using up savings, 39 having difficulty paying for necessities, borrowing money, or having medical bills sent to collection. lso much more likely than their insured counterparts to lack confidence  Uninsured nonelderly adults are a in their ability to afford usual medical costs and major medical expenses or emergencies. Uninsured le to pay costs for normal nonelderly adults are over twice as likely as insured adults to worry about being ab over three quarters of % vs. 26%; Figure 7). Furthermore, uninsured nonelderly adults (76 health care (63 %) say they are very or somewhat worried about paying medical bills if they get sick or have an accident, insured adults. compared to 44% of In 2016, three in ten (30%) of uninsured Lacking insurance coverage puts people at risk of medical debt.  nonelderly adults said they were paying off least one medical bill over time (Figure 7). Medical debts contribute to over half (52%) of debt collections actions that appear on consumer credit reports in the 41 40 and contribute to almost half of all bankruptcies in the United States. Uninsured people United States 42 are more at risk of falling into medical bankruptcy than people with insurance. Though the uninsured are typically billed for medical services they use, when they cannot pay these bills,  the costs may become bad debt or uncompensated care for providers. State, federal, and private funds defray some but not all of these costs. With t he expansion of coverage under the ACA, providers are seeing 43 reductions in uncompensated care costs, particularly in states that expanded Medicaid .  Research suggests that gaining health coverage improves the affordability of care and financial security among the low income population. Multiple studies of the ACA have found larger declines in trouble paying - expansion states. A separate study found that, among those - medical bills in expansion states relative to non income, uninsured individuals, Medicaid expansion significantly - residing in areas with high shares of low 44 party collection agencies. - reduced the number of unpaid bills and the amount of debt sent to third 6 Key Facts about the Uninsured Population

7 M illions of people have gained coverage under the ACA provisions that went into effect in 2014, and current debate over rolling back ACA coverage threaten these gains in coverage and m ake it difficult to reach the 27.6 million who remain without coverage. Proposed policies to change the structure of the Medicaid program or cut back su bsidies for Marketplace coverage may lead to even more uninsured individuals. On the other hand, if additional states opt to expand Medicaid as allowed under the ACA, there may be additional coverage gains as low - income individuals gain access to affordabl e coverage. Going without coverage can have serious health consequences for the uninsured because they receive less preventive care, and delayed care often results in or other health problems The consequences. ancial . Being uninsured also can have serious fin serious illness outcome of current debate over health coverage policy in the United States has substantial implications for being. people’s coverage, access, and overall health and well - Key Facts about the Uninsured Population 7

8 Expansion States 8.1% - 5.5% - 9,110,784 13.6% - 15.8% - 0.5% 15.2% 4,605 Alaska 21.2% 14.0% - 7.1% - 383,719 Arizona 17.8% 9.1% - 8.7% - 206,013 Arkansas 8.7% - 7.6% - 2,526,529 California 16.4% 13.8% 10.8% - 3.1% - Colorado 139,372 Connecticut 11.8% 7.2% - 4.6% - 145,215 8.3% 10.6% 2.3% 20,756 Delaware 8.9% 5.9% - 2.9% - 15,885 District of Columbia 5.7% 6.3% 0.6% Hawaii 7,414 Illinois 11.9% 8.6% - 3.3% - 403,107 7.0% 7.6% - 14.6% - 382,508 Indiana Iowa 9.5% 6.2% - 3.3% - 87,375 Kentucky 7.2% - 9.1% - 351,749 16.3% 16.4% 12.1% - 4.3% - 158,238 Louisiana 7.2% - 6.0% - 309,202 Maryland 13.3% 3.6% 6.4% Massachusetts 161,492 2.7% Michigan 12.1% 7.4% - 4.8% - 412,911 1.0% 6.9% - 7.9% - 52,380 Minnesota Montana 19.0% 8.5% - 10.4% - 85,493 Nevada 10.2% - 11.8% - 270,526 22.0% 5.6% 7.6% - New Hampshire - 65,367 13.2% 4.4% New Jersey 9.0% - 13.4% - 339,457 New Mexico 19.5% 13.0% - 6.5% - 112,780 4.5% New York 6.6% - 11.1% - 775,319 12.1% 8.9% - 3.2% - 19,617 North Dakota 708,788 - 7.4% - Ohio 13.9% 6.5% Oregon 6.2% - 8.0% - 257,142 14.2% 11.6% 5.7% - 5.9% - 647,343 Pennsylvania 5.8% - 5.0% - 43,871 Rhode Island 10.7% 9.1% 6.5% - 2.6% - 13,549 Vermont 8.1% - 5.4% - 299,746 13.4% Washington 5.4% 14.2% 8.8% - West Virginia - 82,642 Non - Expansion States 18.1% 13.3% - 4.8% - 4,575,853 Alabama 10.1% - 7.7% - 305,483 17.8% 7.5% Florida 14.6% - 22.0% - 1,128,462 Georgia 18.5% 13.7% - 4.7% - 334,624 - Idaho 16.8% 10.2% 6.6% - 87,058 Kansas 11.5% 9.8% - 1.7% - 41,999 - 30,792 Maine 11.3% 8.7% - 2.6% Mississippi 13.9% - 2.6% - 63,174 16.4% 9.8% - 3.2% - 168,358 Missouri 13.1% 10.6% 8.2% - 2.4% - 38,713 Nebraska North Carolina 12.4% - 5.0% - 377,650 17.3% 5.7% Oklahoma 12.4% - 18.1% - 163,857 South Carolina 18.9% 10.8% - 8.1% - 297,343 South Dakota 11.6% 9.4% - 2.2% - 15,268 Tennessee 13.2% - 2.0% - 90,107 15.2% 5.7% Texas 17.1% - 22.8% - 1,191,130 Utah 13.7% 13.5% - 0.2% 16,342 1.7% Virginia 11.5% - 13.1% - 125,841 10.4% 8.3% - 2.2% - 98,298 Wisconsin 34,040 - Wyoming 17.5% 11.2% - 6.3% SOURCE: Kaiser Family Foundation analysis of the March 2017 Current Population Survey, Annual Social and Economic Supplement. Key Facts about the Uninsured Population 8

9 Total Nonelderly 100.0% 27.5 100.0% 10.1% 271.1 Age 15.3% Total 28.8% 4.2 78.2 5.4% Children - Total 192.9 71.2% 23.3 Nonelderly Adults 84.7% 12.1% - 29.8 11.0% 3.9 25 14.2% 13.1% - Adults 19 34 39.7 14.7% 6.2 22.7% 15.7% Adults 26 - Adults 35 40.0 14.8% 5.3 19.1% 13.1% - 44 42.0 15.5% 4.3 15.8% 10.3% - 54 Adults 45 64 41.3 15.2% 3.5 Adults 55 8.5% - 12.8% Annual Family Income 24.3% 35.9 6.7 18.6% <$20,000 13.3% - $20,000 43.1 15.9% 6.8 24.9% 15.9% <$40,000 $40,000 + 192.1 70.8% 13.9 50.8% 7.3% Family Poverty Level 36.5 6.5 23.6% 13.5% 17.7% <100% <200% 44.2 16.3% 6.8 100% 15.3% - 24.7% - <400% 78.8 29.1% 31.4% 10.9% 200% 8.6 111.6 41.2% 5.6 20.4% 5.0% 400%+ Household Type 45.0 16.6% 6.7 24.5% 15.0% Single Adults Living Alone 17.7% 13.2% 4.9 13.6% Single Adults Living Together 35.7 37.1 Married Adults 3.2 11.5% 8.5% 13.7% 23.4 8.6% 1 Parent with Children 8.1% 9.5% 2.2 6.6% 19.9% 2 Parents with Children 83.4 5.5 30.7% Multigenerational 5.2% 1.6 5.9% 11.4% 14.2 32.3 11.9% 3.4 12.4% 10.5% Other with Children Family Work Status - time 93.4 34.4% 6.8 24.8% 7.3% 2+ Full 13.7 - 131.1 48.4% time 49.9% 10.4% 1 Full 7.2% - time 19.4 15.1% 2.9 10.7% Only Part Non 27.2 10.0% 4.0 14.6% Workers 14.7% - Race/Ethnicity White 157.5 58.1% 12.0 43.9% 7.6% Black 12.9% 4.1 34.9 14.9% 11.7% 53.6 19.8% 9.1 33.0% 16.9% Hispanic Asian/N. Hawaiian and Pacific Islander 17.1 6.3% 1.4 5.2% 8.3% 2.1 American Indian/Alaska Native 18.9% 0.8% 0.4 1.5% 7.4% Two or More Races 2.1% 0.4 1.6% 5.8 Citizenship U.S. Citizen - Native 233.7 86.2% 19.8 72.3% 8.5% U.S. Citizen Naturalized 15.7 5.8% 1.6 6.0% 10.4% - Non - U.S. Citizen, Resident for <5 Years 5.9 2.2% 1.4 5.0% 23.2% - Non U.S. Citizen, Resident for 5+ Years 15.8 5.8% 4.6 16.7% 29.0% Health Status Excellent/Very Good 68.9% 16.9 186.8 61.5% 9.0% Good 61.9 22.8% 8.0 29.0% 12.9% Fair/Poor 8.3% 2.6 22.4 9.5% 11.7% NOTES: Includes nonelderly individuals ages 0 - 64. The U.S. Census Bureau’s poverty threshold for a family with two adults and one child was $19,318 in 2016. Parent includes any person with a dependent child. Multigenerational/other families with chi ldren include families with at least three generations in a household, plus families in which adults are caring for children other than their own. P art - time workers were defined as working <35 hours per week. Respondents who identify as mixed race who do n ot also identify as Hispanic fall into the “Two or More Races” category. All individuals who identify as Hispanic ethnicity fall into the Hispanic category reg ardless of race. SOURCE: Kaiser Family Foundation a Survey, Annual Social and Economic Supplement. nalysis of the March 2017 Current Population Key Facts about the Uninsured Population 9

10 1 Kaiser Family Foundation analysis of the 2016 National Health Interview Survey 2 Robin A. Cohen, Michael E. Martinez, and Emily P. Zammitti, Health Insurance Coverage: Early Release of Estimates from the (Hyattsville, MD: National Center for Health Statistics, August 2017), National March 2017 Health Interview Survey, January – .pdf https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201708 3 , February 2017 .” Kaiser Family Foundation, 201 7 , State Health Facts. “Total Marketplace Enrollment and Financial Assistance - reform/state indicator/total - marketplace - enrollment - and - financial - assistance/ http://kff.org/health - 4 State Health Facts. “Total Monthly Medicaid and CHIP Enrollment.” Kaiser Family Foundation, June 2017, http://kff.org/health - - indicator/total - monthly - medicaid - and - chip - enrollment/ . reform/state 5 r ACA Coverage Rachel Garfield, Anthony Damico, Cynthia Cox, Gary Claxton, and Larry Levitt , New Estimates of Eligibility fo - ( Kaiser Family Foundation, Jan 2016), - reform/issue Washington, DC: brief/n ew - among the Uninsured http://kff.org/health - of - eligibility - for - aca - coverage - among - the - uninsured/ estimates 6 Bianca DiJulio, Jamie Firth, and Mollyann Brodi, Kaiser Health Tracking Poll: December 2015 , (Washington, D.C.: Kaiser Family - http://kff.org/health - costs/poll - finding/kaiser - health - tracking - poll Foundation, Dec 2015), december - 2015/ 7 2016 Survey of Health Insurance Marketplace Assiste r Programs and Karen Pollitz, Jennifer Tolbert, and Ashley Semanskee. - - reform/report/2016 - su rvey http://www.kff.org/health of - health - Brokers (Washington, DC: Kaiser Family Foundation, June 2016), - marketplace - assister - programs - and - brokers/ insurance 8 Kaiser analysis of the March 201 7 Current Population Survey, Annual Social and Economic Supplement Family Foundation 9 Family Foundation analysis of the March 201 7 Current Population Survey, Annual Social and Economic Supplement Kaiser 10 Kaiser Family Foundation. 2016 Employer Health Benefits Survey (Washington, DC: Kaiser Family Foundation, September 2016), http://kff.org/report - 2016 - summary - of - findings/ section/ehbs - 11 State Health Facts. “ Status of State Action on the Medicaid Expansion Decision .” Kaiser Family Foundation , 201 7, http://kff.org/health - reform/state - indicator/state - activity - around - expanding - medicaid - under - the - affordable - care - act/ 12 Tricia Brooks, Karina Wagnerman, Samantha Artiga, Elizabeth Cornachione, and Petry Ubri, Medicaid and CHIP Eligibility, (Washington, DC: Kaiser Enrollment, Renewal, and Cost Sharing Policies as of January 2017: Findings from a 50 - State Survey and http://www.kff.org/medicaid/report/medicaid - Family Foundation, January 2017), cost - - - chip - eligibilit y - enrollment - renewal - and sharing - as - of - january - 2017 - findings - from - a - 50 - state - survey/ policies - 13 Rachel Garfield and Anthony Damico, – An The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid (Washington, DC: Kaiser Fa mily Foundation, January 2016), http://kff.org/health Update reform/issue - brief/the - coverage - gap - - uninsured - poor - adults - in - states - that - do - not - expand - medicaid - an - update/ 14 Samantha Artiga and Anthony Damico, Health Coverage and Care for Immigrants (Washington, DC: Kaiser Family Foundation, July 2017), http://www.kff.org/disparities - policy/issue - brief/health - coverage - and - care - for - immigrants/ 15 Kaiser Family Foundation analysis of the March 201 7 Current Population Survey, Annual Social and Economic Supplement 16 $19,318 for a family of three in 2016 17 Kaiser Family Foundation analysis of the March 201 7 Current Population Survey, Annual Social and Economic Supplement 18 analysis of the March 201 7 Current Population Survey, Annual Social and Economic Supplement Kaiser Family Foundation 19 201 analysis of the March Family Foundation 7 Current Population Survey, Annual Social and Economic Supplement Kaiser 20 Samantha Artiga and Anthony Damico, Health Coverage and Care for Immigrants (Washington, DC: Kaiser Family Foundation, for http://www.kff.org/disparities policy/issue - brief/health - coverage - and - care - - - immigrants/ July 2017), 21 K aiser Family Foundation analysis of the 2016 National Health Interview Survey 22 Jack Hadley, “Insurance Coverage, Medical Care Use, and Short - term Health Changes Following an Unintentional Injury or the Onset 84. of a Chronic Condition.” 297 , no. 10 (March 2007 ) :1073 - JAMA 23 Stacey McMorrow, Genevieve M . Kenney, and Dana Goin,“Determinants of Receipt of Recommended Preventive Services: Implications for the Affordable Care Act,” American Journal of Public Health 104, no. 12 (Dec 2014): 2392 - 9. 24 K aiser Family Foundation analysis of the 2016 National Health Interview Survey 25 he Onset “Insurance Coverage, Medical Care Use, and Short - term Healt h Changes Following an Unintentional Injury or t Jack Hadley, of a Chronic Condition,” JAMA 297 , no. 10 (March 2007 ): 1073 - 84. Key Facts about the Uninsured Population 10

11 26 et al. Fizan Abdullah, Cause In - Hospital , “Analysis of 23 Million US Hospitalizations: Uninsured Children Have Higher All - 32, no. 2 (June 2010): 236 44. Mortality,” Journal of Public Health - 27 et al. , “Health Insur ance and Mortality in US Adults,” American Journal of Public Health 99, no. 12 (December Andrew Wilper, 2295. 2009): 2289 - 28 eene, , “Insurance Status is a Potent Predictor of Outcomes in Both Blunt and Penetrating Trauma.” American et. al. Wendy Gr Journal of Surgery 7. 199, no. 4 (April 2010): 554 - 29 “The Effect of Insurance Status on Mortality and Procedural ” American Jo urnal of Critical Sarah Lyon, Use in Critically Ill Patients, 184, no. (October 2011 ): 809 - 15. Care Medicine 7 30 Amy Finkelstein et. al, “The Oregon Healt h Insurance Experiment: Evidence from the First Year” (National Bureau of Economic , http://www.nber.org/papers/w17190 Research, July 2011) , 31 Artiga Larisa Antonisse, Rachel Garfield, Robin Rudowitz, and Samantha , The Effects of Medicaid Expansion on the ACA: Findings (Washington , D.C.: Kaiser Family Foundation, Jun 2016), From a Literature Review http://kff.org/medicaid/issue - brief/the - effects - - medicaid - expansion of under - the - aca - findings - from - a - literature - review/ - 32 Mark Hall, “Rethinking Safety Net Access for the Uninsured,” New England Journal of Medicine 364 (January 2011) - 9. :7 33 John Holahan and Brenda Spillman, Health Care Access for Uninsured Adults: A Strong Safety Net is not the Same as Insurance - care - access - uninsured - (Washington, DC: The Urban Institute, January 2002), http://www.urban.org/research/publication/health adults 34 Glied and Kronick , The Value of Health Insurance: Few of the Uninsured Have Adequate Resources to Pay Potential Sherry Richard (Washington , DC: Office of Assistant Secretary for Plann Hospital Bills ing and Evaluation, HHS, May 2011), http://aspe.hhs.gov/health/reports/2011/ValueofInsurance/rb.pdf 35 Uncompensated Care for the Uninsured in 2013: A Detailed Examination , The Kaiser Commission on Medicaid and the Uninsured, (Washington, D.C.: Kaiser Commission on Medicaid and the Uninsured, May 2014), - uncompensated - care - for - the - uninsured - in https://kaiserfamilyfoundation.files.wordpress.com/2014/05/8596 2013.pdf - 36 Glenn Melnick s to Adopt Policies to Protect Uninsured Patients from High , “Fair Pricing Law Prompts Most California Hospital Health Affairs Charges,” - 8. 32, no. 6 (Jun 2013); 1101 37 Stacie Dusetzina , Ethan Basch , and Nancy Keating, “For Uninsured Cancer Patients, Outpatient Charges Can Be Costly, Putting Treatments ou t of Reach, Health Affairs 34 , no. 4 (April 2015 ) : 584 - 591, http://content.healthaffairs.org/content/34/4/584.abstract ” 38 Kaiser Family Foundation analysis of the 2016 National Health Interview Survey 39 Liz Mira Norton, Karen Pollitz, Larry Levitt, Gary Claxton, and Mollyann Brodie , The Burden of Medical Debt: Results from Hamel, , ( Washington, D.C.: Kaiser Family Foundation, Jan 2016), edical Bills Survey the Kaiser Family Foundation/New York Times M - costs/report/the - burden - of - medical - debt - results - from - http://kff.org/health - kaiser - family - foundationnew - york - times - medical - the bills survey/ - 40 mer Financial Protection Bureau, “Consumer Credit Reports: A Study of Medical and Non - Medical Collections.” (Consumer Consu tection Bureau: Financial Pro ), http://files.consumerfinance.gov/f/201412_cfpb_reports_consumer - credit - medical - December 2014 and - non - medical - co llections.pdf 41 , “Medical B ankrupt cy in the United States, 2007: David U. Himmelstein, Deborah Thorne, Elizabeth Warren, Steffie Woolhandler tudy.” ): 741 American Journal of Med icine , 122 , no. 8 ( 2009 Results of a National S - 6, The - http://www.pnhp.org/new_bankruptcy_study/Bankruptcy 2009.pdf 42 Ibid. 43 Larisa Antonisse, Rachel Garfield, Robin Rudowitz, and Samantha Artiga , The Effects of Medicaid Expansion on t he ACA: Findings From a Literature Review (Washington , D.C.: Kaiser Family Foundation, Jun 2016), http://kff.org/r eport - section/the - effects - of - brief/ medicaid expansion - under - the - aca - findings - from - a - literature - review - issue - - 44 Ibid. The Henry J. Kaiser Family Foundation Headquarters: 2400 Sand Hill Road, Menlo Park, CA 94025 | Phone 650- 854 -9400 Washington Offices and Barbara Jordan Conference Center: 1330 G Street, NW, Washington, DC 20005 | Phone 202-347-5270 www.kff.org | Email Alerts: kff.org/email | facebook.com/KaiserFamilyFoundation | twitter.com/KaiserFamFound Filling the need for trusted information on national health issues , the Kaiser Family Foundation is a nonprofit organization based in Menlo Park, California .

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