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Study Estimates Eligibility for Affordable Care Act Coverage Among Uninsured

About half remain eligible for Medicare or marketplace benefits

As of the beginning of 2015, 32.3 million nonelderly people lacked health coverage in the U.S. Nationally, nearly half (15.7 million [49%]) of this population is eligible for financial assistance to gain coverage through either Medicaid or subsidized marketplace coverage under the Patient Protection and Affordable Care Act (PPACA), according to a survey by the Kaiser Family Foundation. The findings were based on the 2015 Current Population Survey and other data sources.

More than a quarter are either adults eligible for Medicaid (5.4 million [17%]) or children eligible for Medicaid or the Children’s Health Insurance Program (CHIP) (3.2 million [10%]). Those who are Medicaid eligible include people who were previously eligible as well as those newly eligible under the PPACA. Approximately one in five (7.1 million [22%]) of the nonelderly uninsured are eligible for premium tax credits to purchase coverage through the Marketplace, Kaiser found. 

In addition, one in ten uninsured people (3.1 million) fall into the coverage gap due to their state’s decision not to expand Medicaid, and 15% of the uninsured (4.9 million) are undocumented immigrants who are ineligible for PPACA coverage under federal law.

The remainder of the uninsured either has an offer of employer-sponsored insurance (ESI) (4.9 million [15%]) or has an income above the limit for premium tax credits but could purchase unsubsidized marketplace coverage (3.7 million [12%]). Kaiser could not determine from available survey data whether an offer of ESI would be considered affordable under the PPACA, which would make the individual ineligible for a marketplace premium subsidy.

According to Modern Healthcare, the federal government is hoping uninsured individuals will sign up for coverage during the PPACA’s upcoming open enrollment period.

The Congressional Budget Office estimates that 33 million people will have a health plan through Medicaid, CHIP, or PPACA exchanges by 2016 –– a large jump from the 17.6 million people who are currently insured under the PPACA.

Sources: Kaiser Family Foundation, October 13, 2015; and Modern Healthcare, October 13, 2014

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