Sara R. Collins, Ph.D. Vice President, Health Care Coverage and Access The Commonwealth Fund

1. Americans’ Experiences with ACA Marketplace and Medicaid Coverage:Access to Care and SatisfactionFindings from The Commonwealth Fund Affordable Care Act Tracking Survey, February – April 2016 Sara R. Collins, Ph.D. Vice President, Health Care Coverage and Access The Commonwealth Fund Media Teleconference May 24, 2016

2. Exhibit 1. Summary of Major Findings • ACA marketplace and Medicaid coverage is enabling people to get health care that many say they could not have gotten before, even among previously insured adults. • Most recent enrollees in marketplace plans or Medicaid say their ability to get the health care they need has improved or stayed the same. • People with marketplace or Medicaid coverage who looked for new primary care physicians found them relatively easily. • Wait times for doctor appointments are comparable to those reported in other surveys. • Majorities of marketplace and Medicaid enrollees are satisfied with their insurance. • The Affordable Care Act has substantially reduced the uninsured rate among working age adults, but wide differences persist between lower and higher income adults.

3. Exhibit 2. Sixty-One Percent of Adults with Marketplace or Medicaid Coverage Who Had Used Their Plan Said They Would Not Have Been Able to Access or Afford This Care Before Prior to getting your Medicaid or health coverage through the marketplace, would you have been able to access and/or afford this care? Percent who said no Adults ages 19–64 who are currently enrolled in marketplace coverage or have had Medicaid for less than three years and have used their new health insurance plan* *72% of adults ages 19 to 64 who are currently enrolled in marketplace coverage or with Medicaid for less than 3 years reported they had used their coverage to visit a doctor, hospital, or other health care provider, or to pay for prescription drugs. Source: The Commonwealth Fund Affordable Care Act Tracking Survey, Feb.-April 2016

4. Exhibit 3. More Than Eight of Ten Adults with New Coverage Said Their Ability To Get Health Care Has Improved or Stayed the Same Since obtaining Medicaid or health coverage through the marketplace, would you say your ability to get the health care that you need has improved, stayed the same, or gotten worse? Percent Adults ages 19–64 who have had a private plan through the marketplace or Medicaid for 2months or less Source: The Commonwealth Fund Affordable Care Act Tracking Survey, February-April 2016

5. Exhibit 4. Six of Ten of Adults with Medicaid or Marketplace Coverage Who Tried to Find a New Primary Care Doctor Found It Very or Somewhat Easy To Do So And Over Half Waited Two Weeks Or Less To See Them How easy or difficult was it for you to find a new primary care doctor or general doctor? How long did you have to wait to get your last appointment to see this doctor? Percent Adults ages 19–64 who are currently enrolled in marketplace coverageor have had Medicaid for less than three years and tried to find a primary care doctor or general doctor since getting new coverage* Note: *25% of adults ages 19 to 64 who are currently enrolled in marketplace coverage or with Medicaid for less than 3 years tried to find a primary care or general doctor. Source: The Commonwealth Fund Affordable Care Act Tracking Survey, Feb.-April 2016.

6. Exhibit 5. Nearly Three of Five Adults with Medicaid or Marketplace Coverage Who Needed To See A Specialist Waited Two Weeks Or Less How long did you have to wait to get your last appointment to see this specialist? Percent Adults ages 19–64 who are currently enrolled in marketplace coverageor have had Medicaid for less than three years and needed to see specialist* Note: *41% of adults ages 19 to 64 who are currently enrolled in marketplace coverage or with Medicaid for less than 3 years needed to see a specialist doctor. Source: The Commonwealth Fund Affordable Care Act Tracking Survey, Feb.-April 2016.

7. Exhibit 6. Most Adults with Marketplace or Medicaid Coverage Continue to be Satisfied with It Overall, how satisfied are you with your health insurance? Somewhat satisfied Very satisfied 93 88 86 85 82 76 81 77 65 Medicaid Marketplace Total Adults ages 19–64 who are currently enrolled in marketplace coverage or have had Medicaid since expansion* *For 2014 we included adults who had Medicaid for less than one year, for 2015 we included adults who had Medicaid for less than 2 years, and for 2016 we include adults who have had Medicaid for less than 3 years. Source: The Commonwealth Fund Affordable Care Act Tracking Surveys, April–June 2014, March–May 2015, and Feb.-April 2016

8. Exhibit 7. Most Adults with Marketplace or Medicaid Coverage Continue to Rate It Highly Now thinking about your health insurance coverage, how would you rate it? Percent of adults 78 77 73 71 75 69 70 66 63 Medicaid Marketplace Total Adults ages 19–64 who are currently enrolled in marketplace coverage or have had Medicaid since expansion* *For 2014 we included adults who had Medicaid for less than one year, for 2015 we included adults who had Medicaid for less than 2 years, and for 2016 we include adults who have had Medicaid for less than 3 years. Source: The Commonwealth Fund Affordable Care Act Tracking Surveys, April–June 2014, March–May 2015, and Feb.-April 2016

9. Exhibit 8. After The End of the Affordable Care Act’s Third Open Enrollment Period, the Percentage of Uninsured U.S. Adults Was 12.7 Percent Percent adults ages 19–64 uninsured Source: The Commonwealth Fund Affordable Care Act Tracking Surveys, July–Sept. 2013, April–June 2014, March–May 2015, and Feb.-April 2016

10. Exhibit 9. Uninsured Rates Among Low-Income Adults Have Fallen The Most But Remain Substantially Higher Than that of Wealthier Adults Percent adults ages 19–64 uninsured Note: FPL refers to federal poverty level. Source: The Commonwealth Fund Affordable Care Act Tracking Surveys, July–Sept. 2013, April–June 2014, March–May 2015, and Feb.-April 2016

11. Exhibit 10. Nearly Half of Adults in Marketplace Plans and Six in Ten Adults Enrolled in Medicaid Were Uninsured Before Getting Their New Insurance What type of health insurance did you have prior to getting your marketplace or Medicaid coverage? Percent Adults ages 19–64 who are currently enrolled in marketplace coverage or have had Medicaid for less than three years Source: The Commonwealth Fund Affordable Care Act Tracking Survey, Feb.-April 2016.

12. Exhibit 11. Over Half of Adults Who Were Uninsured Before Getting Their New Coverage Had Been Uninsured for More than Two Years At the time you got your marketplace or Medicaid coverage, how long had you been uninsured? Percent Adults ages 19–64 who were uninsured before gainingtheir Medicaid or marketplace coverage * Includes those who reported never having had insurance. Source: The Commonwealth Fund Affordable Care Act Tracking Survey, Feb.-April 2016.

13. Exhibit 12. Three of Ten Adults Who Had Employer Insurance for Less Than a Year Previously Had Insurance Through the Marketplaces or Medicaid Why type of health insurance did you have prior to getting health insurance through your current employer? Percent Adults ages 19–64 who have had employer insurance for less than a year Source: The Commonwealth Fund Affordable Care Act Tracking Survey, Feb.-April 2016

14. Exhibit 13. Conclusions • The survey findings suggest that the ACA coverage expansions are facilitating access to needed care and are thus, on balance, working well for the majority of adults enrolled. • Majorities of enrollees are using their insurance to get care many say they could not have accessed or afforded before. • The ability of adults with marketplace plans and Medicaid to find doctors and get appointments is similar to that of U.S. insured adults overall. • This may explain why majorities of enrollees are satisfied with their health insurance. • But a minority of those enrolled indicate problems getting care and are less satisfied.Many people remain uninsured, especially those with low-incomes. • 0ngoing monitoring of the expansions and adjustments by policy makers and stakeholders will be needed to ensure that families can get high quality health care.

15. Exhibit 13. Survey Methodology • Conducted by SSRS from February 2, 2016 to April 5, 2016. • 15-minute telephone interviews in English and Spanish, among a random, nationally representative sample of 4,802 adults ages 19 to 64, living in the United States; 1,496 interviews were on landlines and 3,306 on cellular phones. • Sample was designed to increase likelihood of surveying respondents eligible for new coverage options under the ACAin the following ways: • SSRS re-contacted households reached through their omnibus survey of adults who were uninsured, had individual coverage, had a marketplace plan, or had public insurance. • Stratified Random Digit Dial sample • Data weighted to the U.S. 19-to-64 adult population by age, gender, race/ethnicity, household size, geographic area, and population density and to correct for stratified sample design, the use of re-contacted respondents, overlapping landline and cellular phone sample frames, and disproportionate nonresponse that might bias results. • Overall margin of sampling error of +/-2.0 percentage points at the 95 percent confidence level.