The Briefing Room has written in the past about the millions of Americans who have signed up for coverage since the passing of the Affordable Care Act. However, as the country gears up for its third year of coverage, questions still remain around those who are yet to sign up. Recent Gallup-Healthways polls show that the uninsured rate in America has fallen from 18% at the end of 2013 to 11.4% as of July 2015. That is a drop of nearly six percentage or points in only 18 months meaning millions of Americans have found coverage. This success has been largely attributed to the Affordable Care Act, which focused on enrolling low-income Americans from diverse backgrounds. In fact, since 2014, the largest declines in the uninsured were Black and Hispanic Americans aged 18 to 34 earning less than $36,000 a year.
However, there are roughly 30 million people nationwide who still lack access to affordable, quality health care coverage.
Below is a summary providing insights into who these folks are broken out by key demographics and characteristics. Understanding what this population looks and acts like can help health policy professionals create programs to reach and engage them.
Who are they?
- Young & Savvy: These are often called the “laptops & lattes” crowd. They live in urban metropolitan areas earning $15,000 – $30,000 a year aged 26-34. They are mostly white single men who have graduated from high school and rate themselves as having “Very Good” to “Excellent health”. They are working in the service industry and tend to be “temps” and “freelancers” lacking a steady stream of income.
- Mommy Making Ends Meet: These are single mothers earning less than $25,000 a year mostly under the age of 35 that are predominately African-American and Hispanic. Many have high school equivalent education or less working one or more jobs. However, there is a subset of this group that is no longer in the labor force due to no longer looking for work after long durations of unemployment. Many of these mothers enroll their children into health programs but not themselves; even though many are eligible for Medicaid. Many times their lack of insurance is due to a lack of awareness.
- Dreamers: These are people not eligible for many of the health care programs offered by the government because they are “not lawfully present” in the United States. Despite being employed, most often their jobs pay them in cash, making heir incomes appear lower than the average uninsured person. Being foreign-born often means English is not their first language and they are aged 30-45. Lastly, many of these people live in states that did not increase the Medicaid income eligibility to 138% of the federal poverty level ($16,000) as prescribed in the Affordable Care Act.
- Dissenter/Detractors: These are mostly single white men earning more than $40,000 a year and actually have disposable income to afford health coverage however choose not to buy it. They tend to rate themselves as having very good health and place other priorities above purchasing health insurance. They tend to be older in age (45-64 years old) and have some level of college education or higher.
The Common Thread
The Young & Savvy, Mommies Making Ends Meet, and the Dreamers all have one thing in common. They consider themselves financially insecure. Many have less than $1,000 in savings and have struggled in the past year to provide basic food and shelter for themselves or their loved ones. Additionally, when asked what they would do with more income, many would pay down debt or put money into savings before they would buy health coverage. Many forego health care due to the high cost of out-of-pocket expenses. However despite this, more than three-fourths believe health insurance is very important.
Source: U.S. Department of Health & Human Services , Office of The Assistant Secretary for Planning and Evaluation Health Insurance Marketplace: Uninsured Populations Eligible to Enroll for 2016