In the U.S., uninsured and low-income adults face significant health and health care inequities as compared to insured and higher-income individuals. An issue brief analyzing the Commonwealth Fund 2010 Biennial Health Insurance Survey finds that when low-income adults have access to health insurance coverage and a medical home, they are less likely to report cost-related access problems, more likely to be up-to-date with preventive screenings, and report greater satisfaction with the quality of their care. Moreover, the gaps in health care between them and higher-income populations are significantly reduced. The Affordable Care Act (ACA) includes numerous provisions that will significantly expand health insurance coverage, especially to low-income patients, as well as provisions to promote medical homes. Along with supporting the full implementation of coverage expansions, it will be important for public and private stakeholders to create opportunities that enhance access to medical homes for vulnerable populations.

The Center on Budget and Policy Priorities (CBPP) recently released a report which first describes the Basic Health option, next reviews the issues states should consider in determining whether to adopt it, and finally assesses the issues on which states urgently need federal guidance in order to fully assess the option and whether it is appropriate for them. For more information on the Basic Health program, click here.

A paper recently released by the Center for Economic and Policy Research and Georgetown University uses data from the Current Population Surveys for 1980 through 2011 to review trends in health-insurance coverage rates for low-wage workers (defined as workers in the bottom fifth of the wage distribution in each survey year). In 2010, over 38 percent of low-wage workers lacked health insurance from any source, up from 16 percent in 1979. The biggest reason for the decline in coverage is the erosion of employer-provided health insurance, either through a worker's own employer or as a dependent on another family member's employer-provided policy. Over the last three decades, the role of public insurance in providing coverage for low-wage workers has increased, though not nearly enough to offset the declines in private insurance. In 2010, about 10 percent of low-wage workers had coverage through Medicaid, double the share in 1979. While a great deal of uncertainty still surrounds the Affordable Care Act (ACA) and its likely impact on employers and workers, reasonable estimates based on consensus projections suggest that the ACA will have a substantial positive effect on health-insurance coverage rates for low-wage workers. Even so, the ACA will likely leave an important share of low-wage workers, especially low-wage Latino, African American, and Asian workers, as well as many immigrant workers, without coverage. At the same time, if the ACA is blocked – in the courts or in Congress – there is every indication that coverage rates for low-wage workers will continue their long, steady decline.

According to a new Gallup survey, fewer Americans got their health insurance from an employer in 2011 (44.6%) than in 2010 (45.8%), continuing the downward trend Gallup and Healthways have documented since 2008. As employer-based health insurance has declined, the percentage of Americans who are uninsured has increased, rising to 17.1% this year, the highest seen since 2008. The 25.2% of Americans who had government health insurance (Medicare, Medicaid, or military/veterans' benefits) has not changed since 2010. Two factors appear responsible for the increase in uninsured...

In a new issue brief entitled "The Income Divide in Health Care: How the Affordable Care Act Will Help Restore Fairness to the U.S. Health System," The Commonwealth Fund Health Insurance Tracking Survey of U.S. adults finds nearly three of five adults in families earning less than 133 percent of the federal poverty level were uninsured for a time in 2011. Two of five were uninsured for one or more years. Low- and moderate-income adults who were uninsured during the year were much less likely to have a regular source of health care than people in the same income range who were insured all year. In addition, uninsured lower-income adults were more likely than insured adults in the same income group to cite factors other than medical emergencies as reasons for going to the emergency room. These included needing a prescription drug, not having a regular doctor, or saying that other places cost too much. The report suggests that the Affordable Care Act (ACA) will substantially narrow these inequities through a set of affordable coverage options.

The Urban Institute's paper, "Using the Basic Health Program to Make Coverage More Affordable to Low-Income Households: A Promising Approach for Many States," discusses how proper implementation of Basic Health Programs (BHPs) under the Affordable Care Act (ACA) could create more affordable coverage for low-income households. By implementing a BHP to provide Medicaid-like coverage, modified to add cost-sharing typical of the Children's Health Insurance Program (CHIP), States could substantially reduce coverage costs and expand the number of insurance enrollments. Additionally, successful BHP execution would reduce the burden placed on the health insurance Exchanges and Medicaid. For more information on the Basic Health Program, click here.

A new policy brief issued by the Community Service Society (CSS) of New York examines that state's options related to establishing a Basic Health Program (BHP) under the Affordable Care Act (ACA). The brief, "Bridging the Gap: Exploring the Basic Health Insurance Option for New York," determines that if adopted, a BHP in New York State could provide no-cost coverage to 467,000 low-income residents.

A new study released by the National Bureau of Economic Research (NBER) compares care seeking behavior and health outcomes of individuals covered by insurance with those who are uniunsured, and found better self-reported physical and mental health among those with insurance. The study, "The Oregon Health Insurance Experiment: Evidence from the First Year," offered Oregon Medicaid on a randomly-assigned, lottery basis to an experimental group of uninsured individuals, while the control group received no coverage. Lower out of pocket medical costs were also noted among the group receiving coverage.