Changes in Health Insurance Coverage 2013-2016

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Affordable Care Act drives gains in health coverage, U.S. uninsured rate falls to 10 percent.

The Issue

Analyzing federal data, authors report the number of uninsured Americans fell from 17.0 percent in 2013 to 10.0 percent in 2016—driven by coverage gains spurred by the Affordable Care Act (ACA). The number of people with health insurance coverage rose by 18.5 million during the period.

Key Findings

  • Nationwide, Medicaid expansion fueled a majority of coverage gains (10.9 million people) during the period, and those gains were proportionally higher in the 31 states and the District of Columbia that expanded Medicaid coverage.

  • In expansion states, where 12.6 million gained coverage (9.7 million through Medicaid), the uninsured rated was more than halved (from 15.3% to 7.0%).

  • Non-expansion states experienced coverage gains at a slower rate, with the number of uninsured falling from 19.8 percent to 13.7 percent, an increase of 5.9 million becoming insured.


Across all demographic groups, researchers recorded the largest coverage gains for people with incomes below 138 percent of the federal poverty level. Hispanics, young adults aged 19 to 25, and adults with a high school education or less also experienced significant coverage gains. Adults working in industries that less frequently offer employer-sponsored insurance, such as retail and construction, experienced large gains in coverage through Medicaid and private non-group insurance.

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.

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