Coverage for the Uninsured

The Affordable Care Act (ACA) will expand health insurance coverage by nearly 30 million people—reducing the number of uninsured individuals by more than half. However, about 22 million people will still be left without coverage.

Half of states have not yet accepted the federal money set aside in the Affordable Care Act to expand Medicaid to cover more people with low incomes who can’t afford insurance. As a result, millions of adults in those states will fall into a “coverage gap”: they will not get any of the help paying for insurance that the Affordable Care Act intended to provide them, and will likely remain uninsured.

In addition, after January 1, 2014, certain populations, particularly immigrants, both documented and undocumented, are more likely to remain uninsured.

For those remaining uninsured, finding care they can afford will likely depend on the programs and services offered by local institutions, such as community health centers and hospitals. Without a strong legal framework and good partnerships in place, uninsured and underinsured patients run the risk of accruing medical debt and having difficulty receiving the right care in the right setting.

The ACA requires non-profit hospitals to be transparent about their financial assistance and billing policies, limit hospital charges and collection practices, and routinely assess and address unmet health needs with community and public health input. While this is promising, state and local groups will need to remain informed, involved and vigilant to ensure the needs and voices of the uninsured and underinsured are heard.