Cost-based Underinsurance After the Affordable Care Act

The Affordable Care Act has significantly reduced the number of uninsured individuals in the U.S., yet millions of insured Americans lack adequate coverage or face substantial health-related financial risks. In this study, we conduct an analysis of a nationally representative sample to generate up-to-date evidence on the association between insurance types and demographic factors and the probability of cost-related underinsurance among continuously insured, lower-income adults in the U.S. We extend the previously established definition of underinsurance by including a measure of subjective financial burden. Our estimates suggest that 33.2% of lower-income individuals in our sample were underinsured, with a fourth of them meeting two or three criteria. We also find that Medicaid beneficiaries were significantly less likely than others to experience underinsurance. Our findings provide evidence that underinsurance is a major concern, and expansion of coverage alone may not suffice to protect individuals from financial risks and cost barriers to health care use.