How official health insurance numbers understate consumer risks

Medical services provider Care Better examined research by Amy Finkelstein, co-scientific director, Abdul Latif Jameel Poverty Action Lab (J-PAL) North America, and Liran Einav published in the Proceedings of the National Academy Sciences to assess the level of risk that Americans face of losing healthcare coverage, despite the Affordable Care Act.


How bad is America’s health coverage problem? The country is undoubtedly an outlier among its peers. The United States is the only major industrialized country without universal health coverage, which provides residents with medical services at little-to-no out-of-pocket cost.

This fact has not escaped the attention of lawmakers. The Affordable Care Act, often known as Obamacare, was passed in 2010 to address America’s health coverage gaps. The central portions of the act came into law in 2014 and had a drastic impact almost immediately. The share of Americans aged 18-64 without health insurance fell from around 15% to less than 10%. The latest data suggests just 7.7% of adults under 65 lacked health coverage in the first quarter of 2023.

These results have been a drastic victory for the bill’s proponents, but the headline numbers significantly downplay how much risk Americans still face. Care Better looked at research in the Proceedings of the National Academy of Sciences journal to understand why this might be the case. Their work shows that a startling one-quarter of Americans between 18 and 64 can expect to lose their health coverage at some point two years after they first sign up for insurance.

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