A Snapshot of Uninsured Adults in 2014

Last year marked the first year that healthcare coverage was mandated under the Patient Protection and Affordable Care Act (ACA); however, a number of American adults remained uninsured at the end of 2014. A recent Kaiser Health Survey examined demographics of the uninsured population compared with those who were continuously or newly insured.
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According to the survey, approximately 11 million nonelderly adults were newly insured in 2014 due to the ACA and Medicaid expansion, while 30 million people reported that they were uninsured as of the date of the interview. Some were ineligible for coverage under the ACA due to immigration status or because their state did not expand Medicaid coverage.

The study found that the uninsured population polled in the fall of 2014 resembled the population that has historically lacked coverage as well as the population who newly gained coverage in 2014. Adults who gained coverage in 2014 were similar in age to those who did not. Of the newly insured population, 18% were 19 to 25 years of age, 30% were 26 to 34 years of age, 20% were 35 to 44 years of age, and 32% were 45 to 64 years of age. Of the individuals who remained uninsured, 22% were 19 to 25 years of age, 28% were 26 to 34 years of age, 20% were 35 to 44 years of age, and 30% were 45 to 64 years of age.

In addition, more than half of the population that remained uninsured (54%) had a family income of ≤138% of the federal poverty level (FPL), which is the income range that provides eligibility for Medicaid coverage; however, of the newly insured individuals, a comparable 53% had a family income of ≤138% of the FPL.

Nearly 1 in 4 uninsured individuals (38%) had family incomes that would qualify them to receive tax credits (139%-400% of the FPL). This distribution was also similar in the newly insured population (42%).

For those who remained uninsured in 2014, access to employer-based coverage was limited for reasons including they are self-employed or not in a working family (44%), their employer does not offer coverage (27%), or they are ineligible for coverage (6%).

Coverage transition also played a role in uninsured rates, as 21% of the uninsured population polled had lost their coverage in 2014 due to a change in employer-sponsored coverage (55%) or Medicaid (16%).

Uninsured adults were also more likely than those with coverage to say their health is fair or poor, but they were less likely to have a diagnosed medical condition. Of those who rated their overall health as fair to poor, 36% were uninsured, 27% were newly insured, and 18% were continuously insured. Of those who said they were taking a prescription, 26% were uninsured, 36% were newly insured, and 49% were continuously insured.

The survey found that Hispanic individuals remained disproportionately represented among those who were uninsured in 2014 (36%) compared with Hispanics who were newly insured (24%) and Hispanics who were continuously insured (13%).

Despite the availability of the Children’s Health Insurance Program, the survey found that adults who remained uninsured were more likely than those with coverage to have uninsured children (24%).

The survey included 10,502 nonelderly adults and took place between September 2, 2014, and December 15, 2014. The majority of the interviews (70%) were conducted prior to November 15, 2014, which began the start of the second year of open enrollment for health insurance on the exchange.—Kerri Fitzgerald