The Affordable Care Act (ACA) and recent reductions in marketplace premiums have brought U.S. uninsured rates to record lows, with most working-age Americans covered throughout the year. However, a new Commonwealth Fund survey shows that coverage gaps remain, and health plans — including those offered by employers, which cover most people — do not always guarantee affordable or timely access to care. The report suggests ways policymakers can expand coverage and lower costs for consumers.
Fielded between March and June of 2024, the Commonwealth Fund 2024 Biennial Health Insurance Survey asked a nationally representative sample of adults ages 18 to 64 about their experiences with health insurance. The survey found that about one of five respondents had been uninsured at some point during the year, and nearly a quarter (23%) who had insurance were underinsured — that is, enrolled in health plans with high out-of-pocket costs that make it difficult to afford care. Among those underinsured, two-thirds (66%) had coverage through an employer, 14 percent had individual or marketplace plans, and 11 percent were enrolled in Medicaid. More than half (57%) reported forgoing care because of cost and 44 percent said they carry medical debt.