HKS Authors

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The Affordable Care Act (ACA) is more than a decade old, but universal health care coverage in the United States remains elusive. An underappreciated fact about the roughly 28 million uninsured Americans is how many of them already qualify for subsidized coverage. It has been estimated that 57% of uninsured people in 2019 qualified for Medicaid or subsidized marketplace coverage, and 40% qualified for insurance plans with no premiums—either Medicaid or state health insurance marketplace plans (typically plans in the least generous “bronze” tier). 1 To reduce the proportion of uninsured Americans, policymakers have focused on increasing marketplace subsidies and persuading holdout states to expand Medicaid. But policies that broaden eligibility for affordable coverage, though necessary, are unlikely to completely close the coverage gap.


McIntyre, Adrianna, and Mark Shepard. "Automatic Insurance Policies — Important Tools for Preventing Coverage Loss." The New England Journal of Medicine 386.5 (February 2022): 408-411.