Who Gained Health Insurance Coverage Under the ACA, and Where Do They Live?

A doctor checks a patient's ears with an otoscope.

The rate and number of insured Americans reached historic highs in the years following passage of the Affordable Care Act (ACA).



The Issue

The analysis provides state-by-state breakdowns by key demographics of the 19 million people who gained coverage under the ACA from 2010 to 2015.

Key Findings

  • Among nonelderly adults gaining coverage, 14.1 million did not have a college degree; within this group, 44 percent were non-Hispanic white.

  • In California, 3.8 million people gained coverage and the uninsured rate dropped 53.4 percent after state policymakers expanded Medicaid eligibility.

  • In Florida and Texas, 3.2 million people gained coverage, even though the states did not expand Medicaid.


Coverage rates increased broadly across age, gender, race/ethnicity, education, and state. A large share of the nonelderly adult coverage gains occurred among those without a college degree—87 percent. Fifty-seven percent of the children and adults gaining coverage were nonwhite or Hispanic.

About the Urban Institute

The nonprofit Urban Institute is dedicated to elevating the debate on social and economic policy. For nearly five decades, Urban scholars have conducted research and offered evidence-based solutions that improve lives and strengthen communities across a rapidly urbanizing world. Their objective research helps expand opportunities for all, reduce hardship among the most vulnerable, and strengthen the effectiveness of the public sector. Visit the Urban Institute’s Health Policy Center for more information specific to its staff and its recent research.