Medicare provides health insurance for 98 percent of Americans aged 65 and over.
Who lacked/lacks health insurance before/since the Affordable Care Act (ACA)?
Group Before ACA Today Difference.
All Americans under 65 16.4 percent 11.3 percent -31 percent.
Hispanic-Mexicans 26.2 percent 16.5 percent -37 percent
Blacks 24.1 percent 16.1 percent -33 percent.
Whites 14.1 percent 10.0 percent -29 percent
Asians 13.6 percent 9.7 percent -29 percent
Aged between 18 and 34, 21.6 percent 14.2 percent -34 percent
Aged 35 to 44 16.4 percent 11.2 percent -32 percent
Aged 45 to 54 15.0 percent 10.6 percent -29 percent
Aged 55 to 64 12.7 percent. 9.1 percent -28 percent
Poorest 20 percent of neighborhoods 26.4 percent 17.5 percent -36 percent
Next poorest 20 percent 21.6 percent 14.3 percent -34 percent
Middle 20 percent, 17.6 percent 11.9 percent -33 percent
Next highest 20 percent 13.4 percent 9.4 percent -30 percent
Richest 20 percent 6.5 percent 6.5 percent ————–
Overall and within almost all groups, the ACA has reduced the uninsured by about one-third. Still, two-thirds of those who were uninsured before the ACA remain uninsured today.
Why hasn’t a plan intended to provide almost all Americans with health insurance come anywhere near to achieving that goal? In large measure, the failures of this part of the ACA go back to its design. The ACA originally sought to coerce the states into expanding Medicaid to cover many of those who are uninsured today. In 2012, the Supreme Court rejected that component of the plan. States were left free to expand or not expand Medicaid. So far, twenty-seven states have chosen to expand Medicaid, while twenty-three have rejected it.
Why did many states reject Medicaid expansion? One answer would be Republican wrecking tactics directed against the center-piece of President Obama’s agenda. However, not all Republican-led states rejected expansion and not all Democratic-led states accepted it.
It is possible that rational calculation played a role. The states that rejected expansion had an average uninsured rate of 18.2 percent before the ACA, while those that accepted expansion had an average uninsured rate of 14.9 percent. Federal subsidies for expanded Medicaid are scheduled to be reduced in a few years. States will have to increase their share of the expanded costs. Many of the states that rejected Medicaid expansion pursue a low-tax strategy to attract business. Other parts of the ACA were not completely thought through. Perhaps the failure to make the complete Federal subsidy permanent is another such “glitch.” It will take a Democratic House, Senate, and White House to fix it.
Even in states that expanded Medicare, 9.2 percent of people remain without insurance. Why? Ignorance? A libertarian resistance to coercive good intentions? Most Republicans have an ideological opposition to an “entitlement” that was forced on them by Democrats. Unlike post-war Europe, there is no consensus on this issue.
Kevin Quealy and Margot Sanger-Katz, “Obama’s Health Law: Who Was Helped Most,” NYT, 29 October 2014.
 Understates the gain because it doesn’t include the three million people who are allowed to remain on parents’ insurance.