Who Are the Remaining Uninsured and Why Haven't They Signed Up for Coverage? Findings from the Commonwealth Fund Affordable Care Act Tracking Survey, FebruaryApril 2016

The number of uninsured people in the United States has declined by an estimated 20 million since the Affordable Care Act went into effect in 2010. Yet, an estimated 24 million people still lack health insurance. Goal: To examine the characteristics of the remaining uninsured adults and their reasons for not enrolling in marketplace plans or Medicaid. Methods: Analysis of the Commonwealth Fund ACA Tracking Survey, February–April 2016. Key findings and conclusions: There have been notable shifts in the demographic composition of the uninsured since the law's major coverage expansions went into effect in 2014. Latinos have become a growing share of the uninsured, rising from 29 percent in 2013 to 40 percent in 2016. Whites have become a declining share, falling from half the uninsured in 2013 to 41 percent in 2016. The uninsured are very poor: 39 percent of uninsured adults have incomes below the federal poverty level, twice the rate of their overall representation in the adult population. Of uninsured adults who are aware of the marketplaces or who have tried to enroll for coverage, the majority point to affordability concerns as a reason for not signing up

Tailoring electrostatic surface potential and adsorption capacity of porous ceramics by silica-assisted sintering

In this study, we apply silica-assisted sintering to develop porous yttria stabilized zirconia (YSZ) ceramics with tailored electrostatic surface potential and adsorption capacity as a promising alternative to chemical functionalization. The porous bodies were formed by partial sintering at 1050 °C and were investigated regarding the influence of admixtures of silica particles on sintering behavior, microstructural evolution and the resulting mechanical and surface properties of the material, particularly the surface potential. With increasing silica concentration, the sintering mechanism was gradually changed from solid state to liquid phase sintering, due to the wetting of YSZ by liquid silica and a resulting inhibition of mass transport, particle growth and diffusion-induced densification. Most importantly, due to the silica layer development, the isoelectric point (IEP) of the YSZ/silica material surfaces was systematically shifted towards the IEP of silica from pH 9.4 to 1.2 resulting in a more pronounced negative surface potential at neutral pH. The relationship between surface IEP and silica concentration was mathematically described using the IEPs of the starting materials, the YSZ particle radius and the glass layer thickness. This estimation allows us to tailor the surface coverage of the YSZ matrix with silica as well as the resulting electrostatic surface potential. We further demonstrate how the applied processing route can be effectively used to develop ceramics with specified adsorption capacities for protein immobilization for use in filtration, bioprocessing or biomaterial applications. © 202

The Rise in Health Care Coverage and Affordability Since Health Reform Took Effect (Biennial 2014)

New results from the Commonwealth Fund Biennial Health Insurance Survey, 2014, indicate that the Affordable Care Act's subsidized insurance options and consumer protections reduced the number of uninsured working-age adults from an estimated 37 million people, or 20 percent of the population, in 2010 to 29 million, or 16 percent, by the second half of 2014. Conducted from July to December 2014, for the first time since it began in 2001, the survey finds declines in the number of people who report cost-related access problems and medical-related financial difficulties. The number of adults who did not get needed health care because of cost declined from 80 million people, or 43 percent, in 2012 to 66 million, or 36 percent, in 2014. The number of adults who reported problems paying their medical bills declined from an estimated 75 million people in 2012 to 64 million people in 2014

How the Affordable Care Act Has Helped Women Gain Insurance and Improved Their Ability to Get Health Care

Issue: Prior to the Affordable Care Act (ACA), one-third of women who tried to buy a health plan on their own were either turned down, charged a higher premium because of their health, or had specific health problems excluded from their plans. Beginning in 2010, ACA consumer protections, particularly coverage for preventive care screenings with no cost-sharing and a ban on plan benefit limits, improved the quality of health insurance for women. In 2014, the law's major insurance reforms helped millions of women who did not have employer insurance to gain coverage through the ACA's marketplaces or through Medicaid.Goals: To examine the effects of ACA health reforms on women's coverage and access to care.Method: Analysis of the Commonwealth Fund Biennial Health Insurance Surveys, 2001–2016.Findings and Conclusions: Women ages 19 to 64 who shopped for new coverage on their own found it significantly easier to find affordable plans in 2016 compared to 2010. The percentage of women who reported delaying or skipping needed care because of costs fell to an all-time low. Insured women were more likely than uninsured women to receive preventive screenings, including Pap tests and mammograms

The Problem of Underinsurance and How Rising Deductibles Will Make It Worse: Findings from the Commonwealth Fund Biennial Health Insurance Survey, 2014

New estimates from the Commonwealth Fund Biennial Health Insurance Survey, 2014, indicate that 23 percent of 19-to-64-year-old adults who were insured all year -- or 31 million people -- had such high out-of-pocket costs or deductibles relative to their incomes that they were underinsured. These estimates are statistically unchanged from 2010 and 2012, but nearly double those found in 2003 when the measure was first introduced in the survey. The share of continuously insured adults with high deductibles has tripled, rising from 3 percent in 2003 to 11 percent in 2014. Half (51%) of underinsured adults reported problems with medical bills or debt and more than two of five (44%) reported not getting needed care because of cost. Among adults who were paying off medical bills, half of underinsured adults and 41 percent of privately insured adults with high deductibles had debt loads of $4,000 or more

Too High a Price: Out-of-Pocket Health Care Costs in the United States

Whether they have health insurance through an employer or buy it on their own, Americans are paying more out-of-pocket for health care now than they did in the past decade. A Commonwealth Fund survey fielded in the fall of 2014 asked consumers about these costs. More than one of five 19-to-64-year old adults who were insured all year spent 5 percent or more of their income on out-of-pocket costs, not including premiums, and 13 percent spent 10 percent or more Adults with low incomes had the highest rates of steep out-of-pocket costs. About three of five privately insured adults with low incomes and half of those with moderate incomes reported that their deductibles are difficult to afford. Two of five adults with private insurance who had high deductibles relative to their income said they had delayed needed care because of the deductible

Are Americans Finding Affordable Coverage in the Health Insurance Marketplaces? Results from the Commonwealth Fund Affordable Care Act Tracking Survey

By the end of the first open enrollment period for coverage offered through the Affordable Care Act's marketplaces, increasing numbers of people said they found it easy to find a plan they could afford, according to The Commonwealth Fund's Affordable Care Act Tracking Survey, April–June 2014. Adults with low or moderate incomes were more likely to say it was easy to find an affordable plan than were adults with higher incomes. Adults with low or moderate incomes who purchased a plan through the marketplaces this year have similar premium costs and deductibles as adults in the same income ranges with employer-provided coverage. A majority of adults with marketplace coverage gave high ratings to their insurance and were confident in their ability to afford the care they need when sick

Americans' Experiences with Marketplace and Medicaid Coverage

The latest Commonwealth Fund Affordable Care Act Tracking Survey finds the share of uninsured working-age adults was 13 percent in March–May 2015, compared with 20 percent just before the major coverage expansions went into effect. More than half of adults who currently have coverage either through the Affordable Care Act's (ACA's) marketplace plans or Medicaid expansion were uninsured prior to gaining coverage. Of those, more than 60 percent lacked coverage for one year or longer. More than six of 10 adults who used their new plans to obtain care reported they could not have afforded or accessed it previously. Majorities of people with ACA coverage who have used their plans express satisfaction with the doctors covered in their networks and are able to find physicians with relative ease. Wait times to get appointments with physicians in marketplace plans and Medicaid are comparable to those reported by other working-age adults