Healthcare Coverage & Access

The uninsured rate among non-elderly American Indians and Alaska Natives (AI/ANs) decreased from 32.4 percent in 2010 to 19.9 percent in 2022 – however, the AI/AN population continues to have the highest uninsured rate compared to other racial and ethnic populations.

Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPIs) experienced larger relative gains in health insurance coverage than any other racial or ethnic group in the United States since the Affordable Care Act was enacted in 2010.

The uninsured rate for nonelderly Latinos decreased from 32.7 percent to 18.0 percent, from 2010 to 2022, however, Latinos are more than twice as likely to be uninsured as non-Latino Whites.

Recent legislative and administrative policy initiatives have built on the Affordable Care Act’s (ACA) expansion of health insurance coverage and improvements in access to and utilization of health care services.

Since the implementation of the Affordable Care Act’s coverage provisions, the uninsured rate among nonelderly Black Americans decreased by 10 percentage points, from 20.9 percent in 2010 to 10.8 percent in 2022.

This issue brief presents Marketplace enrollment and plan selections by race and ethnicity among 2015-2023 Open Enrollment Period enrollees in HealthCare.gov states using combined self-reported race and ethnicity information with imputed data for missing values.

The Affordable Care Act substantially transformed the market for non-group private health insurance, introducing new consumer protections and coverage standards and establishing Health Insurance Marketplaces.

This Issue Brief presents current estimates of enrollment in health insurance coverage obtained through the ACA Marketplaces and the Medicaid expansion and the subsequent reductions in state-level uninsured rates since the ACA was implemented in 2014.

The Inflation Reduction Act’s (IRA) expanded financial assistance in Medicare’s Low-Income Subsidy (LIS) Program would have benefited nearly 461,000 Partial LIS enrollees had the provision been in effect in 2020. An additional 2.9 million Part D enrollees who were eligible but not enrolled in LIS would also have benefited from the program.

The cornerstone of a well-functioning market is competition. President Biden’s Executive Order 14036, “Promoting Competition in the American Economy” identified a lack of competition as a key driver for problems across economic sectors.