A Decade of Coverage Losses: Implications for the Affordable Care Act

This report, which was funded by the Robert Wood Johnson Foundation as part of a project to track Affordable Care Act (ACA) implementation, analyzes coverage trends among children, parents and adults without dependent children as a guide to changes in coverage that could be expected in the coming years without ACA.

Authored by researchers at the Urban Institute, the report finds that from 2000 to 2010, there were pronounced declines in employer-sponsored insurance (ESI) among all non-elderly groups, with more substantial declines occurring among lower-income groups, and increased uninsurance rates for adults. As these trends persist across both periods of recession and recovery—both of which took place within the last decade—among all income groups, it is likely that without ACA, there would be continuing declines in ESI and increases in the number of uninsured. The authors note, however, that Medicaid and the Children’s Health Insurance Program (CHIP) were particularly effective at reducing the number of uninsured children, even during the recent economic downturn.

The authors conclude that parents and adults without dependent children are the two groups that stand to gain the most from both ACA’s Medicaid expansions and subsidized coverage available through state insurance exchanges. They add that if these coverage-related provisions are not implemented, the number of uninsured is predicted to grow significantly in the coming years.

This report is one in a series of briefs examining coverage trends among different groups targeted by ACA coverage expansions.