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Health Care Coverage and Access

Background

ASPE conducts a variety of research and data analyses on health care coverage and access issues. Listed below by date of publication are ASPE Issue Briefs, Reports, Data Points and other research products on these issues and related topics.

 

Publications

2024

2023

  • State and Local Estimates of the Uninsured Population in the U.S. Using the Census Bureau’s 2022 American Community Survey
    To support state and local outreach efforts, ASPE has developed state and sub-state estimates of the number of uninsured, along with their demographic characteristics, who may qualify for coverage through Qualified Health Plans (QHPs) in the Health Insurance Marketplace (“QHP-eligible uninsured”) using the most recent Census data available for this purpose.
  • National Uninsured Rate Remained Unchanged in the Second Quarter of 2023
    This Data Point examines new National Health Interview Survey (NHIS) data to assess recent changes in health coverage for the population. The national uninsured rate in the second quarter of 2023 was 7.2 percent, unchanged statistically from the first quarter of 2023. An estimated 10.4 percent of adults ages 18-64 and 3.7 percent of children ages 0-17 years were uninsured in Q2 of 2023. These rates are not significantly different from the corresponding estimates from Q1 2023.
  • Inflation Reduction Act Research Series: Medicare Enrollees’ Use and Out-of-Pocket Expenditures for Drugs Selected for Negotiation under the Medicare Drug Price Negotiation Program
    The Inflation Reduction Act (IRA) authorizes the Secretary of the Department of Health and Human Services (HHS) to negotiate prices directly with participating manufacturers for selected drugs that have high total spending and are high expenditure, single source drugs without generic or biosimilar competition. Negotiations with participating manufacturers for the first group of selected drugs for initial price applicability year 2026 begin in 2023, with negotiated maximum fair prices going into effect in 2026. This Fact Sheet provides descriptive information on the use and out-of-pocket spending in calendar year 2022 for each of the drugs selected for negotiation for initial price applicability year 2026 under the Medicare Drug Price Negotiation Program. We examined the use of these 10 drugs and out-of-pocket spending on them for Medicare Part D enrollees overall, by low-income subsidy (LIS) status, by demographic characteristics, and by state of residence.
  • National Uninsured Rate Reaches an All-Time-Low in Early 2023
    This Data Point examines new National Health Interview Survey (NHIS) data to assess recent changes in health coverage for the population. The most recent data finds that the national uninsured rate for all ages declined 1.9% from 2019 to 2022, with early 2023 data showing even greater decreases reaching an all-time low national uninsured rate of 7.7%. This reduction in the uninsured rate reflects 6.3 million people gaining coverage since 2020. The Data Point also examines data from the American Community Survey to assess state level coverage changes.
  • State Fact Sheets: Impacts of the IRA and ACA on Lowering Health Care Costs
    These Fact Sheets highlight health care cost savings achieved under the Inflation Reduction Act (IRA) and the Affordable Care Act (ACA) for each of the fifty states and the District of Columbia. Enrollee savings on Medicare Part D out-of-pocket costs, insulin, vaccines, and Marketplace premiums are presented. Gains in health coverage also are highlighted along with the latest enrollment data for Medicare, Medicaid and Marketplace.
  • State Medicaid Telehealth Coverage Policy Decisions Since the COVID-19 Public Health Emergency
    ASPE contracted with RAND Health Care to catalogue and assess state changes to Medicaid telehealth policies during the COVID-19 PHE through May 2022 and identify the driving circumstances, motivations, and evidence supporting telehealth policy decisions during the COVID-19 Public Health Emergency (PHE). The purpose of this study was to review changes to state Medicaid telehealth policies and/or new policies enacted during the COVID-19 PHE, examining policies that were rolled back, as well as those made permanent in part or in whole.
  • Medicaid Enrollees Who are Employed: Implications for Unwinding the Medicaid Continuous Enrollment Provision
    This Issue Brief examines federal survey data for Medicaid enrollees who report they are employed and highlights changes from 2019 to 2021, reflecting the COVID-19 pandemic and subsequent policy actions that may have affected employment status, and provides additional information on potential transitions from Medicaid to ESI.
  • State Level Estimates of Medicaid Enrollees Currently Working and their Demographic Characteristics
    ASPE has developed national and state estimates of the number of U.S. residents enrolled in Medicaid, along with data on employment, income, and demographic characteristics of those who are currently working, using the most recent Census data available from the 2021 American Community Survey (ACS).
  • Medicaid After Pregnancy: State-Level Implications of Extending Postpartum Coverage (2023 Update)
    This brief provides an overview of the important role Medicaid plays in postpartum maternal health, reviews states’ existing pregnancy-related Medicaid eligibility limits, and assesses the projected eligibility impact if all states were to provide 12 months of postpartum Medicaid eligibility. This Issue Brief updates a previous report that was originally published in December 2021.
  • Health Coverage Under the Affordable Care Act: Current Enrollment Trends and State Estimates
    This Issue Brief presents current estimates of enrollment in health insurance coverage obtained through the Affordable Care Act (ACA) Marketplaces, Medicaid expansion, Children's Health Insurance Program, Basic Health Program and the subsequent reductions in state-level uninsured rates since the ACA was implemented in 2014. As of early 2023, the report finds that more than 40 million Americans have coverage under the ACA, the highest total on record.
  • Children’s Health Coverage Trends: Gains in 2020-2022 Reverse Previous Coverage Losses
    This Issue Brief examines children’s health coverage trends from 2010 through the third quarter of 2022 and reviews recent research findings on children’s access to and utilization of health care services during this period, including the COVID-19 pandemic. The report concludes with a discussion of recently enacted policies related to health coverage, including expanded Marketplace subsidies and 12-month continuous eligibility in Medicaid/CHIP for children, elimination of the “Family Glitch” that affected Marketplace subsidy eligibility, and the potential coverage implications of the end of the Medicaid continuous enrollment provisions on March 31, 2023.
  • Changes in Health Insurance Coverage, 2019-2021: Geographic and Demographic Patterns in the Uninsured Rate
    This Issue Brief examines the composition of the population that is uninsured and highlights changes in uninsured rates by geography and demographic factors from 2019 to 2021, during a time of significant federal policy efforts to expand coverage. The analysis shows that the national uninsured rate declined during this period, with larger coverage gains for younger adults; Latino, American Indian, and Alaska Native individuals; non-English speaking adults; and people living in states that recently expanded Medicaid. This report follows a recent ASPE release of a state- and local-level dataset on the uninsured population in the U.S. that uses the newly-released 2021 American Community Survey (ACS).

2022

  • State Medicaid Telehealth Policies Before and During the COVID-19 Public Health Emergency: 2022 Update
    This issue brief provides updates on state Medicaid policies regarding delivery of telehealth services by provider types and modalities, as of January 2022. The COVID-19 pandemic substantially accelerated interest in and utilization of telehealth across all payers including Medicaid. State Medicaid telehealth coverage policies and adoption of new flexibilities provided under the COVID-19 public health emergency (PHE) vary. Several states have made PHE-related telehealth flexibilities permanent while other policies have expired.
  • State and Local Estimates of the Uninsured Population in the U.S. Using the Census Bureau’s 2021 American Community Survey
    This publication provides an update to a previous ASPE report on state, county, and local estimates of the uninsured population by using newly available data from the 2021 American Community Survey.
  • HealthCare.gov Enrollment by Race and Ethnicity, 2015-2022
    This Data Point presents changes in HealthCare.gov enrollment by race and ethnicity from 2015-2022 using a validated imputation method for missing information on race and ethnicity.
  • Unwinding the Medicaid Continuous Enrollment Provision: Projected Enrollment Effects and Policy Approaches
    This report provides current HHS projections of the number of individuals predicted to lose Medicaid coverage at the end of the COVID-19 public health emergency (PHE) due to a change in eligibility or due to administrative churning. The report also predicts eligibility for alternative insurance coverage among those predicted to lose Medicaid eligibility and highlights legislative and administrative actions that can help minimize disruptions in coverage, including the passage of the Inflation Reduction Act, which provides enhanced Marketplace subsidies for 3 years that will benefit some individuals leaving Medicaid at the end of the PHE.
  • National Uninsured Rate Reaches All-Time Low in Early 2022
    This Data Point examines new Health Interview Survey data to assess recent changes in coverage, finding that the uninsured rate declined throughout 2021 and early 2022 – reaching a historic low of 8.0% by the first quarter of 2022. This reflects 5.2 million people gaining coverage since 2020. The report also examines data from the American Community Survey to assess coverage changes among low-income adults in states with recent Medicaid expansions.
  • Marketplace Coverage and Economic Benefits: Key Issues and Evidence
    This report highlights the impacts of the Affordable Care Act's Marketplace subsidies on coverage rates among self-employed adults and small business owners, based on tax data from the Department of Treasury and national survey data. The report also reviews the research evidence on the impact of health coverage on consumer financial security, which has been aided by the enhanced subsidies provided through the American Rescue Plan.
  • Imputation of Race and Ethnicity in Health Insurance Marketplace Enrollment Data, 2015 – 2022 Open Enrollment Periods
    The Assistant Secretary for Planning and Evaluation (ASPE) contracted with RAND Health Care to develop methods for imputing race and ethnicity among people who selected Marketplace plans on HealthCare.gov but did not report their race or ethnicity, and to apply these methods to data from the 2015 to 2022 Open Enrollment Periods. This technical report describes the imputation methods applied and presents summary enrollment statistics post imputation.
  • Health Coverage Changes Under the Affordable Care Act: End of 2021 Update
    This report examines recently-released 2021 National Health Interview Survey data to assess coverage changes during the pandemic, finding a decrease in the uninsured rate in 2021 for the population as a whole and by race, ethnicity, and income. The report also examines the most recent enrollment statistics for coverage related to the Affordable Care Act, including Marketplace, Medicaid expansion, and the Basic Health Program, finding that enrollment by early 2022 has hit an all-time high of more than 35 million people.
  • HealthCare.gov Marketplace Enrollment During the 2021 Special Enrollment Period by Race and Ethnicity
    This issue brief presents Marketplace enrollment for plan selections, enrollment channels, average monthly premiums, and gender by race and ethnicity among 2021 HealthCare.gov Special Enrollment Period enrollees using combined self-reported race and ethnicity information with imputed data for missing values.
  • Projected Coverage and Subsidy Impacts If the American Rescue Plan’s Marketplace Provisions Sunset in 2023
    This Data Point highlights projected losses in Marketplace subsidies and health coverage if the American Rescue Plan (ARP) premium tax credit provisions for Marketplace coverage are not extended.
  • Health Coverage for Women Under the Affordable Care Act
    Over 10 million adult women (19-64) gained coverage between 2010 and 2019, as did over 7 million women of reproductive age (15-44). Despite these coverage gains, approximately 7.9 million women of reproductive age remain uninsured. Access to comprehensive and continuous health coverage for women, particularly those of reproductive age, is critical to improving maternal and infant health. This brief examines the population of remaining uninsured women, including demographics and pathways to coverage.
  • The Affordable Care Act and Its Accomplishments
    This Briefing Book features key findings from two dozen reports published in 2021-2022. The Briefing Book summarizes key findings in five areas:
    • Health Coverage and Uninsured Rates
    • Marketplace Coverage
    • Medicaid
    • Preventive Care
    • Populations of Interest
  • Health Insurance Coverage and Access to Care Among Black Americans: Recent Trends and Key Challenges
    This issue brief analyzes changes in health insurance coverage and access to care among Black Americans using data from 2011-2020, with a focus on impacts of the Affordable Care Act and the American Rescue Plan.
  • Estimates of Uninsured Adults Newly Eligible for Medicaid If Remaining 12 Non-Expansion States Expand Medicaid: 2022 Update
    This Data Point presents updated estimates of potential Medicaid eligibility among uninsured, non-elderly adults in states that have not expanded Medicaid coverage to adults with incomes up to 138% of the federal poverty level as of 2022.
  • Health Coverage Changes From 2020-2021
    This Data Point uses recently-released National Health Interview Survey data along with employment and Marketplace enrollment information to examine the trends in uninsurance rates by income, age, and coverage type during 2020 and the first three quarters of 2021. Findings indicate that uninsured rates for the U.S. population have decreased since the last quarter of 2020, and that legislative and administrative actions such as the American Rescue Plan, state Medicaid expansions and the 2021 Marketplace Special Enrollment Period have helped Americans maintain health coverage during the COVID public health crisis.
  • Health Insurance Deductibles Among HealthCare.gov Enrollees, 2017-2021
    This report examines trends in deductible costs among HealthCare.gov enrollees and individuals with employer coverage, demonstrating the impact of the Affordable Care Act's cost-sharing reductions on affordability.

2021

  • Facilitating Consumer Choice: Standardized Plans in Health Insurance Marketplaces
    This report provides an overview of the evidence to date on how standardized plans can potentially benefit consumers, improve health equity, and enhance plan competition. This brief also describes the current landscape of standardized plans in State-based Marketplaces and the current proposal to add standardized plans to HealthCare.gov for Plan Year 2023. 
  • Medicaid After Pregnancy: Potential State-Level Effects of Extending Postpartum Coverage
    This brief provides an overview of the important role Medicaid plays in postpartum maternal health, reviews existing pregnancy-related Medicaid eligibility limits in state Medicaid programs, and assesses the projected eligibility impact if all states were to extend postpartum Medicaid eligibility to 12 months.
  • Assessing Uninsured Rates in Early Care and Education Workers
    This Data Point presents health insurance coverage rates among early care and education (ECE) workers (those serving young children birth to age five) compared to the general population and other educators (elementary school teachers, high school teachers, and post-secondary school instructors and professors), and assesses geographic patterns in coverage rates for preschool and kindergarten teachers.
  • Tracking Health Insurance Coverage in 2020-2021
    This issue brief highlights challenges using federal survey data for estimates on health coverage and uninsurance in 2020 and early 2021, examines alternative data sources for insights into coverage changes, and summarizes what is known to date about the uninsured population during this period.
  • Health Insurance Coverage and Access to Care Among Latinos: Recent Trends and Key Challenges
    Health outcomes among Latinos are affected by factors such as lack of health insurance, language and cultural barriers, and lack of access to care. This issue brief analyzes changes in health insurance coverage and examines disparities in access to care between Latinos and non-Latinos using data from 2013-2020. This Issue Brief is part of a series of ASPE Issue Briefs examining the change in coverage rates after implementation of the ACA among select racial and ethnic populations. 
  • Reaching the Remaining Uninsured: An Evidence Review on Outreach and Enrollment
    In 2020, approximately 30 million U.S. residents lack health insurance, and the majority were already eligible for some form of federally-subsidized coverage, primarily Medicaid or Marketplace private insurance. Participation rates and outreach are therefore key considerations in policies designed to expand coverage. This Issue Brief reviews evidence on factors affecting enrollment in health coverage among uninsured populations, including take-up of Medicaid and subsidized Marketplace plans among eligible individuals.
  • The American Rescue Plan and the Unemployed: Making Health Coverage More Affordable After Job Loss
    This Issue Brief examines the UC premium tax credit and cost-sharing reduction provisions under the ARP, describes the populations likely to benefit from these new temporary provisions, and provides illustrative examples to highlight the possible household impacts of these provisions.
  • Health Insurance Coverage and Access to Care for American Indians and Alaska Natives: Current Trends and Key Challenges
    The uninsured rate among American Indian and Alaska Native (AI/AN) working age adults decreased 16 percentage points since the passage of the ACA, from 44 percent in 2010 to 28 percent in 2018. This Issue Brief describes changes in the uninsured rate, health coverage, and access to care for AI/ANs since 2013 and discusses key policies for this population, including how the American Rescue Plan Act of 2021 (ARP) builds on the Affordable Care Act (ACA) and invests additional resources in the Indian health care system.
  • State Medicaid Telehealth Policies Before and During the COVID-19 Public Health Emergency
    States have embraced Medicaid telehealth flexibilities during the COVID-19 Public Health Emergency (PHE), enhancing beneficiary access to services delivered via telehealth. All states now cover primary care and behavioral health services delivered via telehealth. Many states have expanded coverage for telehealth modalities to include telephone-only, text-based communication, and remote patient monitoring, as well as authorizing patients’ homes as an originating site. This Issue Brief examines state Medicaid telehealth coverage and policies before and after the COVID-19 PHE was declared in January 2020.
  • Health Coverage Under the Affordable Care Act: Enrollment Trends and State Estimates
    Based on enrollment data from late 2020 and early 2021, approximately 31 million people are currently enrolled in Marketplace or Medicaid expansion coverage related to provisions of the Affordable Care Act (ACA), the higher total on record. This Issue Brief presents current estimates of enrollment in health insurance coverage purchased through the ACA Marketplaces and the Medicaid expansion and the subsequent reductions in state-level uninsured rates since the ACA was implemented in 2014.
  • Estimates of Uninsured Adults Newly Eligible for Medicaid If Remaining Non-Expansion States Expand
    Approximately 4.0 million uninsured non-elderly adults would be newly eligible for Medicaid if non-expansion states were to expand eligibility for adults to 138% of the Federal Poverty Level (FPL). This Data Point presents estimates of potential Medicaid eligibility among uninsured, non-elderly adults in states that have not expanded Medicaid coverage to adults with incomes up to 138% of the Federal Poverty Level (FPL) and the demographic characteristics of this population.
  • Health Insurance Coverage Changes Since Implementation of the Affordable Care Act: Asian Americans and Pacific Islanders
    This Issue Brief is the first in a series examining the impact of the Affordable Care Act (ACA) on health coverage rates among select racial and ethnic populations. Changes in coverage rates from 2013-2019 are examined.
  • Count Estimates of Zero- and Low-Premium Plan Availability in HealthCare.gov States Pre and Post ARP, by Metal Tier, Select Demographics, and State
    These supplemental data tables are for the ASPE Issue Brief series, Access to Marketplace Plans with Low Premiums on the Federal Platform, that examines the availability of zero-premium and low-premium (defined as less than or equal to $50 per month) plans in states served by the federal Marketplace platform, HealthCare.gov, before and after the passage of the American Rescue Plan Act of 2021.
  • Access to Marketplace Plans with Low Premiums on the Federal Platform Part III: Availability Among Current HealthCare.gov Enrollees Under the American Rescue Plan
    This Issue Brief is the third in a series that examines the availability of zero-premium and low-premium plans in states served by the federal Marketplace platform, HealthCare.gov. Estimates highlight the impact of the American Rescue Plan’s (ARP) enhanced and expanded Marketplace premium tax credit provisions. Specifically, the analysis compares the availability of zero-premium and low-premium health plans, pre and post ARP, among current HealthCare.gov enrollees.
  • Medicaid Churning and Continuity of Care: Evidence and Policy Considerations Before and After the COVID-19 Pandemic
    This Issue Brief reviews evidence on churning among the Medicaid population and different policy options for states and the federal government to reduce churn, including continuous eligibility, Medicaid expansion to adults, express lane eligibility, presumptive eligibility, multimarket plans, and limiting premiums and cost-sharing.
  • Access to Marketplace Plans with Low Premiums on the Federal Platform, Part II: Availability Among Uninsured Non-Elderly Adults Under the American Rescue Plan
    This Issue Brief is the second in a series that examines the availability of zero-premium and low-premium plans in states served by the federal Marketplace platform, HealthCare.gov. Estimates in this brief are based on the enhanced premium subsidies available under the American Rescue Plan (ARP) for 2021 coverage through HealthCare.gov. This Issue Brief compares the availability of health plans for zero- and low-premiums among uninsured non-elderly adults eligible for Marketplace coverage in HealthCare.gov states, pre- and post-ARP. The impacts of the ARP on Marketplace advanced premium tax credit (APTC) subsidies and premiums after application of APTC among currently enrolled nonelderly adults will be examined in a subsequent Issue Brief.
  • Access to Marketplace Plans with Low Premiums on the Federal Platform, Part I: Availability Prior to the American Rescue Plan
    This Issue Brief is the first in a series that examines the availability of zero-premium and low-premium plans in states served by the federal Marketplace platform, Healthcare.gov. Estimates in this brief are based on the premium subsidies available as of March 1, 2021, which does not include the enhanced subsidies created by the American Rescue Plan (ARP). The impacts of the ARP on Marketplace advanced premium tax credit (APTC) subsidies and premiums after application of APTC will be examined in a subsequent Issue Brief.
  • The Remaining Uninsured: Geographic and Demographic Variation
    This Issue Brief illustrates the geographic and demographic variation in the uninsured population, including those eligible to enroll in Marketplace coverage during the COVID-19 Special Enrollment Period.
  • State, County, and Local Estimates of the Uninsured Population: Prevalence and Key Demographic Features
    To support state and local outreach efforts, ASPE has developed state and sub-state estimates of the number of uninsured, along with their demographic characteristics, who are likely to qualify for coverage through Qualified Health Plans (QHPs) in the Health Insurance Marketplace (“QHP-eligible uninsured”) using the most recent Census data available for this purpose.
  • Medicaid Demonstrations and Impacts on Health Coverage: A Review of the Evidence
    This issue brief examines policies in four major areas of state Medicaid section 1115 demonstrations: 1) work requirements (also referred to as “community engagement” requirements), 2) healthy behavior incentive programs, 3) health savings account-like arrangements, and 4) capped federal funding and other financing changes and reviews the evidence to date on the impact of these demonstration policies on Medicaid coverage and access to care.
  • Trends in the U.S. Uninsured Population, 2010-2020
    Newly released estimates from the National Health Interview Survey show that 11.1 percent of U.S. residents (or 30.0 million) under age 65 lacked health insurance as of January-June 2020. This number reflects a sharp decline in the number of uninsured Americans since 2010, before implementation of the Affordable Care Act's large coverage expansions. The implementation of the Affordable Care Act increased coverage especially for Blacks, Latinos, Asians, American Indians/Alaska Natives, families with lower incomes, and those living in states that expanded Medicaid. However, the uninsured rate rose between 2016-2019. The issue brief concludes with an overview of current efforts to expand health coverage.

2018

  • Health Plan Choice and Premiums in the 2019 Federal Health Insurance Exchange
    This brief presents information on qualified health plans (QHPs) available in the Exchange for states that use the HealthCare.gov platform, including estimates for issuer participation, health plan options, premiums, and subsidies in the upcoming open enrollment period (OEP), and trends since the first OEP. National estimates and summary tables are presented in each section of the text.

2017

2016

2015

2014

2013

2012

2011