News & Commentary

8 years after ACA passage: fewer uninsured, but more underinsured


About 45% of adults ages 19 to 64 are inadequately insured today, about the same number as in 2010, when the ACA was passed. But there have been significant shifts, according to the Commonwealth Fund’s latest Biennial Health Insurance Survey. Fewer adults are uninsured today, and those who find themselves uninsured can expect to be that way for a shorter duration of time.

Growing problem of underinsurance

Percentage of adults, ages 19–64

Source: “Health Insurance Eight Years After the ACA,” Commonwealth Fund Biennial Health Insurance Survey, Feb. 7, 2019

However, the problem of underinsurance has grown. The Commonwealth Fund defines underinsured as people whose out-of-pocket costs, excluding premiums, over the prior year are equal to 10% or more of household income; or their out-of-pocket costs, excluding premiums, over the prior year are equal to 5% or more of household income for individuals living under 200% of the federal poverty level ($24,120 for an individual or $49,200 for a family of four); or their deductible constitutes 5% or more of household income.

Of the 194 million U.S. adults ages 19 to 64 in 2018, an estimated 87 million, or 45%, were inadequately insured under the Commonwealth Fund’s definition. The greatest increase has been seen among the 158 million Americans who get coverage from an employer.