Changes in Healthcare Cost Barriers with Medicaid Continuous Coverage and Enhanced Premium Tax Credits

The Issue

Healthcare coverage, access, and affordability are key drivers of health and wellbeing in the United States. 

Key Findings

• The share of adults who reported delaying or forgoing needed medical care because of cost declined from 12.1% in 2019 to 9.7% in 2022.
• Among adults with family incomes below 138% of the federal poverty level (FPL), researchers saw a 27% reduction in cost barriers. Researchers saw a 19% reduction for families between 138% and 249% of the FPL.
  • Researchers say these two groups benefited the most from the continuous coverage requirement and enhanced Marketplace tax credits.
• The overall share of uninsured adults declined from 14.5% in 2019 to 12.4% in 2022, and the share who had continuous full-year coverage increased from 82.1% to 84.4%.
• Adults in states that expanded Medicaid between 2019 and 2022 experienced the largest decline in uninsurance, from 17.2% to 11.0%, and the largest increase in full-year coverage, from 80.0% to 85.8%.

Conclusion

Researchers say the end of Medicaid's continuous coverage requirement and the coming expiration of enhanced Marketplace tax subsidies could make recent coverage gains difficult to sustain. 

About the Author/Grantee

The nonprofit Urban Institute is dedicated to elevating the debate on social and economic policy. For nearly five decades, Urban scholars have conducted research and offered evidence-based solutions that improve lives and strengthen communities across a rapidly urbanizing world. Their objective research helps expand opportunities for all, reduce hardship among the most vulnerable, and strengthen the effectiveness of the public sector. Visit the Urban Institute’s Health Policy Center for more information specific to its staff and its recent research.