30 million newly-insured under the Affordable Care Act: Who are they?

Who are the newly insured under the ACA?

Of the 30 million newly-insured Americans under the ACA, 32% will gain coverage from Medicaid, 45% from the individual exchanges, and 23% from their employers. The newly-insured will be less educated, more racially diverse, and more than twice as likely to speak a primary language other than English. They are more likely to be under/unemployed, with many cycling between Medicaid and the subsidized exchanges.

Two reports from PwC's Health Research Institute (HRI) analyzes the newly insured population and the new Medicaid population in Health insurance exchanges: Long on options, short on time and Medicaid expansion: New patients, new challenges.

State by state progress on ACA implementation

Exchange population

What will the individual exchange members look like?

In 2014, nine of 10 individual exchange members will receive federal subsidies. Individual exchange population will grow to about 29 million in 2021, generating $205 billion in premium revenue.

Medicaid expansion

What will the new Medicaid population look like?

Under ACA, approximately 11 million individuals under age 65 who will be gaining Medicaid coverage by 2021, as this graphic illustrates.

Learn more: Explore the data

Data modeler

Health Insurance Exchanges: Long on options, short on time

One year from now, 12 million Americans are expected to begin purchasing health insurance through newly-created marketplaces known as exchanges. Federal subsidies will entice many would-be participants to the program that will offer coverage starting in 2014. By 2021, the size of the exchange market is projected to more than double, marking the single largest expansion of health coverage in this country since the creation of Medicare in 1965.

States have until November 16 to notify the Department of Health and Human Services on whether they plan to form their own distinct marketplaces or collaborate with the federal government to operate an exchange. Many are waiting for the November election results before deciding how to proceed. This wait-and-see stance leaves an increasingly short decision window, which in turn shortens the time available for implementation by states and insurers.

Thus far, 13 states and the District of Columbia have issued formal letters of intent to establish their own exchanges, but not all will be ready for enrollment by October 2013. The majority of the remaining 37 states will have the federal government directly involved in running their exchanges—eight states have already chosen to have a federally-facilitated exchange, while three have selected an approach that divides duties in a state/federal “partnership.” Public exchanges will create an irreversible shift in the insurance market that will ultimately change the way medical care is sold in the US.

For the insurance industry, the new state-based exchanges represent a major business opportunity—an estimated $205 billion in premiums by 2021.

But thriving in this new market won’t be easy. Insurers will continue their battle to keep a balance of healthy and sick members to limit adverse selection. Providers and insurers will face clear challenges in serving a new customer base with a demographic profile and health needs that differ from today’s insured population in meaningful ways.

States will carry the responsibility to make consumers aware of new coverage and financial assistance options. Success will require a firm grasp on emerging public exchange models, a sophisticated understanding of the individuals who will be purchasing coverage and the skill to help consumers navigate an increasingly complex health system.

Private exchanges, already up and running in a handful of markets, may serve as innovation models in this new purchasing environment—targeting employers and consumers seeking lower costs, greater transparency and convenience.

Newly insured vs. Currently insured

New exchange vs. Current privately insured

New Medicaid vs. Current Medicaid

Family status
Work status
Health status
Note: Percentages may not equal 100 percent due to rounding.Sources: PwC HRI analysis, Current Population Survey, Medical Expenditure Panel Survey.

Dig into the demographics: Launch this interactive data modeler to compare the newly vs. currently insured, new exchange participants vs. the current privately insured, and the new Medicaid population vs. those currently covered by Medicaid.