Despite ACA expansion, many still go without health insurance

Over the past few years, the number of people who have been able to get health insurance for the first time has increased significantly, adding millions of Americans to the rolls of those who have coverage. However, there are still millions more who continue to go without, and their numbers are actually still larger than those who gained such coverage. And now, experts are starting to get a better idea of exactly what kinds of people are still struggling to obtain health insurance.

Today, about 1 in 4 people between the ages of 19 and 64 who would be eligible for health insurance through the Patient Protection and Affordable Care Act's mandated exchanges with incomes of less than 138 percent of the federal poverty level are still without coverage, according to a new study from the Commonwealth Fund. That number was down from 35 percent as recently as 2013, but indicates the nation still has a long way to go when it comes to getting everyone reasonably covered.

The ACA has helped millions get health insurance, but more needs to be done.

A demographic breakdown
However, it's worth noting that there are a lot of sub-groups in this mix that may be at lesser or greater risk than the group average when it comes to being uncovered, the report said. For instance, those working at smaller businesses have a 24 percent uninsured rate, down from nearly 1 in 3 a few years ago. Meanwhile, the uninsurance rate for Latinos is still quite high at 29 percent, but improved from the 36 percent seen in 2013.  It is possible this percentage remains high due to undocumented residents being ineligible for coverage on the exchanges.

Nearly 18 percent of adults under the age of 35 are uninsured, which is down from 28 percent three years ago, the report said. Furthermore, just 13 percent of African-Americans in this group do not have health insurance these days, down from 21 percent.

Fortunately, those who were previously most at-risk for going without coverage have also seen the biggest improvements in uninsurance rates during the three-year period in question, the report said. Today, only about 21 percent of people making less than 250 percent of the federal poverty level go without insurance, down from the nearly 1 in 3 who were in the same category three years prior.

Potential issues looming
On the other hand, it's not all good news for those who plan to buy coverage through state or federal exchange websites in the next few years, according to a study from Avalere. One of the keystones of the ACA – and its ability to provide consumers with the lowest-cost coverage possible while still being at least somewhat comprehensive – is that many major health insurers will compete for the previously uninsured consumer population. Now, it seems as though that may not happen as hoped in many parts of the country.

More than one-third of the regions across the U.S. are expected to have no competition in the insurance marketplaces for the 2017 open enrollment period, and more than half are expected to have two or fewer insurers participating, the report said. That number is actually rising nationwide, meaning that diminished competition is becoming more common.

“Depending on where consumers live, their choice of insurance plans may decrease for 2017,” said Elizabeth Carpenter, senior vice president at Avalere. “Some exchange enrollees may need to choose another insurance plan in order to maintain coverage.”

With all this in mind, it might be vital for health insurers across the U.S. to do more to connect with uncovered consumers of all backgrounds. Carriers can help the uninsured find better ways to understand their coverage and get a better handle on what will be required of them for the 2017 open enrollment period.