DATA BRIEF JULY 2020 Gap Closed: INTRODUCTION Eliminating racial inequities in insurance coverage was one of the main goals of the Affordable Care Act (ACA). Prior to the law, people of color were uninsured at significantly The Affordable higher rates than whites. Recent research has indicated that these gaps have narrowed,1 although remaining disparities within the Black, Latino, Native American/Alaska Native Care Act’s communities have been starkly exposed during the COVID-19 pandemic.2 Asian Americans are the fastest-growing racial or ethnic group in the United States.3 Surveys and research analyses often group Asian Americans with other races or ethnicities, Impact on limiting what we know about the way this group experiences health care. Asian Americans are composed of more than 50 distinct ethnicities with significant socioeconomic diversity. Asian Americans’ Chinese, Indian, and Filipino Americans are the three largest groups. After implementation of the ACA, the uninsured rate declined among all races and Health Coverage ethnicities through 2016. Prior research has reported on the reduction and elimination of coverage disparities between Asian American and white adults, including significant gains among the lower-income population.4 In this brief, we build on those previous findings by extending the analysis of different Asian American ethnicities through 2018 and exploring the reduction in disparities by income, insurance type, and Medicaid expansion. Specifically, we use two-year rolling averages to review: • Insurance coverage rates for Asian Americans compared to other races and ethnicities, as well as rates for specific Asian American ethnicities and subpopulations. • Coverage trends among different income groups and those living in Medicaid Munira Z. Gunja expansion states to better understand specific effects of ACA provisions on the Asian American population. Jesse C. Baumgartner Understanding the effects of the ACA on Asian American coverage can provide important Arnav Shah insights for eliminating remaining coverage inequities for Black, Latino, and other racial David C. Radley and ethnic communities — at a moment when racial injustice has been laid bare. It Sara R. Collins also can help us identify remaining coverage challenges for different Asian American populations moving forward. Gap Closed: The Affordable Care Act’s Impact on Asian Americans’ Health Coverage 2 KEY HIGHLIGHTS The ACA helped eliminate the coverage gap between Asian American and white adults. In 2010–2011, Asian Americans were significantly more likely to be uninsured compared to whites. By 2017–2018, Asian Americans had the lowest uninsured rate of any racial or ethnic group in the U.S. Uninsured rates have fallen among all Asian American subgroups since the passage of the ACA, but not uniformly. Korean, Vietnamese, and other Asian Americans were significantly more likely to be uninsured in 2017–2018, compared to Indian, Chinese, and Filipino Americans. Since the passage of the ACA, the coverage disparity between Asian Americans and whites was eliminated across all income categories through coverage gains within Medicaid, the individual and ACA marketplaces, and employer-based insurance. The largest reduction in disparities occurred within the subgroup of adults earning between 138 percent and 399 percent of the federal poverty level ($16,753 to $48,439 for an individual in 2018). The vast majority of Asian Americans live in Medicaid expansion states, which has helped to drive down their overall uninsured rate. But since the passage of the law, the coverage gap has been eliminated between Asian Americans and white adults in both expansion and nonexpansion states. commonwealthfund.org Data Brief, July 2020 Gap Closed: The Affordable Care Act’s Impact on Asian Americans’ Health Coverage 3 The TheACA ACAeliminated eliminatedthethe insurance coverage insurance gap between coverage Asian Americans gap between and whites. Asian Americans and whites. Percent of adults ages 19–64 who were uninsured In 2010–2011, prior to the ACA’s coverage expansions, working- age Asian Americans were more likely to be uninsured compared 42.6 to whites, and had the second- 40.6 lowest uninsured rate compared to all other races and ethnicities, 36.0 35.8 including Black and Latino adults. The coverage disparity between Asian Americans and whites stood at 4.2 percentage Native American/ points, with 19.5 percent of Asian 25.5 Americans uninsured compared 24.4 25.4 Alaska Native 22.0 22.1 25.0 Latino to 15.3 percent of whites. By 2017– 2018, the gap had disappeared. The uninsured rate among 19.5 18.7 Asian Americans improved by 15.3 14.2 Black more than 11 percentage points, 14.7 Native Hawaiian/ 11.9 dropping their overall uninsured Pacific Islander 8.5 White rate to 7.9 percent, the lowest 7.9 Asian American rate of any racial or ethnic group, including whites. For the full period, Native 2010–11 2011–12 2012–13 2013–14 2014–15 2015–16 2016–17 2017–18 Hawaiians/Pacific Islanders and Native Americans/Alaska Data: Commonwealth Fund analysis of the American Community Survey (2010–2018). Natives had significantly higher uninsured rates than Asian Munira Z. Gunja et al., Gap Closed: The Affordable Care Act’s Impact on Asian Americans’ Health Coverage (Commonwealth Fund, July 2020). Americans. These two groups are often grouped with Asian Americans for purposes of survey Data: Commonwealth Fund analysis of the American Community Survey (2010–2018). research. commonwealthfund.org Data Brief, July 2020 Gap Closed: The Affordable Care Act’s Impact on Asian Americans’ Health Coverage 4 Uninsured Uninsured rates rates across across all Asian all Asian American American subpopulations subpopulations dropped, dropped, with with Indians the Indian Americans least the least likely to be likely to be uninsured byuninsured 2017–2018. by 2017–2018. Percent of adults ages 19–64 who were uninsured We examined Asian Americans by six different subgroups: Indian, Chinese, Filipino, Korean, Vietnamese, and other Asian Americans, which include over 15 31.3 additional ethnicities. All these 29.3 populations experienced at least a 7 percentage-point decline in 26.4 the uninsured rate since 2010– 25.0 2011, but gains varied. Koreans 21.6 experienced a 20.5-point drop in 20.6 20.6 their uninsured rate, compared to 21.3 a 7.7-point drop among Filipinos. 17.7 18.0 Although coverage gains occurred 14.6 across all subgroups, Korean, 14.3 14.2 12.3 Total U.S. Vietnamese, and other Asian 13.2 10.8 Korean Americans were still significantly 10.3 Other more likely to be uninsured in 9.8 Vietnamese 7.6 Chinese 2017–2018 compared to Indian, 6.5 Filipino Chinese, and Filipino Americans. 5.4 Indian 2010–11 2011–12 2012–13 2013–14 2014–15 2015–16 2016–17 2017–18 Data: Commonwealth Fund analysis of the American Community Survey (2010–2018). Munira Z. Gunja et al., Gap Closed: The Affordable Care Act’s Impact on Asian Americans’ Health Coverage (Commonwealth Fund, July 2020). Data: Commonwealth Fund analysis of the American Community Survey (2010–2018). commonwealthfund.org Data Brief, July 2020 Gap Closed: The Affordable Care Act’s Impact on Asian Americans’ Health Coverage 5 The AsianAmerican–white The Asian American–white coverage coverage disparity disparity had had been been eliminated eliminated across all poverty across all poverty categories categories byby 2017–2018. 2017–2018. Percent of adults ages 19–64 who were uninsured We compared uninsured rates of Asian Americans and whites across different income brackets <138% FPL 138%–399% FPL 400%+ FPL to better highlight the impact of specific ACA provisions. Disparities that existed before the ACA was implemented have Asian American closed within each income group, 37.4 though the size of the coverage 35.7 gains varied across the levels. 35.4 33.6 White 25.9 25.4 18.4 19.2 18.4 16.6 11.8 7.9 7.4 11.0 3.6 5.3 5.2 3.6 Note: FPL = federal poverty level. Data: Commonwealth Fund analysis of the American Community Survey (2010–2018). Munira Z. Gunja et al., Gap Closed: The Affordable Care Act’s Impact on Asian Americans’ Health Coverage (Commonwealth Fund, July 2020). Note: FPL = federal poverty level. Data: Commonwealth Fund analysis of the American Community Survey (2010–2018). commonwealthfund.org Data Brief, July 2020 Gap Closed: The Affordable Care Act’s Impact on Asian Americans’ Health Coverage 6 Less than 138 percent of the poverty level. 138 percent to 399 percent of the poverty 400 percent or more of the poverty level. Adults who earn less than 138 percent of level. Adults who earn between 100 percent Adults who earn 400 percent or more of the federal poverty level ($16,753 for an and 399 percent of poverty ($12,140–$48,439 poverty can enroll in coverage through the individual and $34,638 for a family of four for an individual and $25,100–$100,149 for marketplaces, but they are not eligible for in 2018) may be eligible for different forms a family of four in 2018) and are legally subsidies. The ACA made coverage more of coverage depending on their state of present in the United States may be eligible accessible and comprehensive even for those residence and immigration status.5 for subsidized health insurance through not eligible for subsidies through the ban on the ACA marketplaces. This group also may preexisting condition exclusions, community Adults within this income range who are include lawfully present adults with incomes ratings, and other insurance market reforms. lawfully present and live in states that under 138 percent of poverty who are in the Even prior to the implementation of the ACA, expanded Medicaid under the ACA are five-year waiting period to enroll in Medicaid uninsured rates had consistently been lower eligible to enroll in their state’s Medicaid and are eligible to enroll in subsidized for this income group across all races and program.6 As of 2018, 77 percent of the Asian coverage through the marketplace.9 ethnicities (data not shown). American population lived in states that had expanded Medicaid.7 Adults in nonexpansion The Asian American–white coverage The Asian American–white coverage states are eligible for subsidies through the disparity within this income group started disparity within this income group was 2.6 ACA marketplaces if they earn more than at 6.7 percentage points in 2010–2011; but percentage points in 2010–2011. By 2017–2018, 100 percent of poverty and do not have by 2017–2018, the gap had closed, and the disparity had been eliminated and an affordable offer of employer coverage. Asian Americans were no more likely to be the uninsured rate for whites and Asian Importantly, lawfully present immigrants uninsured than whites. Americans was the same. who are in the five-year waiting period for Medicaid are eligible for marketplace subsidies even if they earn below 100 percent of poverty.8 In 2010–2011, Asian Americans in this income group were more likely to be uninsured compared to whites (37.4% to 35.4%). However, by 2017–2018, the gap between Asian Americans and whites reversed, with whites more likely to be uninsured than Asian Americans. commonwealthfund.org Data Brief, July 2020 Gap Closed: The Affordable Care Act’s Impact on Asian Americans’ Health Coverage 7 Asian Americans Asian Americans eliminated eliminated the coverage the coverage gap through gap through improvements improvements in the private market in the private and Medicaid. market and Medicaid. Percent of adults ages 19–64 with different forms of insurance coverage, 2010–2011 vs. 2017–2018 Asian American adults eliminated the coverage gap with white adults through gains in the 10.5 individual market, Medicaid, and Asian American (2010–11) 13.1 employer-sponsored insurance. Asian American (2017–18) Individual These improvements were larger 7.7 White (2010–11) than those reported by whites. White (2017–18) 9.2 The share of Asian Americans in these forms of coverage 7.0 increased between 2010–2011 and 2017–2018. These data are 11.4 consistent with other research Medicaid showing that Asian Americans 5.6 are geographically concentrated 8.9 within Medicaid expansion states and are effectively accessing the Medicaid and individual 60.7 insurance markets — two of 65.5 the ACA’s main strategies for Employer increasing coverage.10 66.7 Increases in employer-sponsored 68.4 insurance can be linked to ACA coverage requirements for individuals and employers, as Data: Commonwealth Fund analysis of the American Community Survey (2010–2018). well as overall improvements in the economy through 2018, which Munira Z. Gunja et al., Gap Closed: The Affordable Care Act’s Impact on Asian Americans’ Health Coverage (Commonwealth Fund, July 2020). spurred employment growth. Data: Commonwealth Fund analysis of the American Community Survey (2010–2018). commonwealthfund.org Data Brief, July 2020 Gap Closed: The Affordable Care Act’s Impact on Asian Americans’ Health Coverage 8 In states that expanded Medicaid eligibility as well as states that did not, Asian Americans In states that expanded Medicaid eligibility as well as states that did not, Asian Americans experienced greater experienced greater gainsgains ininsurance in health health insurance coverage coverage compared compared to whites. to whites. Percent of adults ages 19–64 who were uninsured In Medicaid expansion states as well as nonexpansion states, Asian Americans had larger coverage gains compared to whites in both relative and absolute terms. As a result, the coverage disparity between the two groups has been eliminated across both groups of states. Still, whites and Asian Americans in states that haven’t expanded 18.2 17.4 Medicaid are uninsured at higher rates than those in states that 17.6 17.1 have expanded. 13.9 13.2 12.2 White, state has not expanded Medicaid Asian American, state has 6.5 expanded Medicaid 6.3 White, state has expanded Medicaid 2010–11 2011–12 2012–13 2013–14 2014–15 2015–16 2016–17 2017–18 Data: Commonwealth Fund analysis of the American Community Survey (2010–2018). Munira Z. Gunja et al., Gap Closed: The Affordable Care Act’s Impact on Asian Americans’ Health Coverage (Commonwealth Fund, July 2020). Data: Commonwealth Fund analysis of the American Community Survey (2010–2018). commonwealthfund.org Data Brief, July 2020 Gap Closed: The Affordable Care Act’s Impact on Asian Americans’ Health Coverage 9 POLICY IMPLICATIONS • The fact that undocumented immigrants are ineligible for The Affordable Care Act’s coverage expansions have improved health Medicaid or marketplace coverage; 13 an estimated 1.7 million Asian insurance coverage for Asian Americans and all racial and ethnic Americans are undocumented.14 groups. However, notable disparities remain, particularly among Blacks, With Black, Latino, and other communities still facing significant gaps, Hispanics, Native Americans/Alaska Natives, and Native Hawaiians/ there are numerous policy options for covering more people and Pacific Islanders. Asian American adults entered 2010 with relatively low achieving equity within insurance coverage: uninsured rates — the second-lowest behind whites. Benefiting from the ACA’s coverage expansions, by 2018 Asian Americans had the lowest Expand Medicaid without work requirements or other restrictions in uninsured rate of any racial or ethnic group. However, the coverage the remaining nonexpansion states. Research shows that 81 percent disruptions from COVID-19 may affect coverage in this community; the of Asian American nonelderly adults currently live in states that have unemployment rate for Asian Americans soared to 15 percent in May. In expanded Medicaid, compared to 66 percent of the overall adult addition, over half of minority-owned businesses are owned by Asian population, meaning that these communities have disproportionately Americans, which may put this group at increased risk of losing their benefited from this key ACA coverage provision.15 In contrast, only 54 businesses and coverage in the pandemic-driven recession.11 percent of Black adults live in these states, which has limited the equity effects of the ACA for the Black community. The Asian American progress has been driven by gains across both public and private insurance plans, with nearly identical coverage The expansion of Medicaid in additional states without barriers such improvements in Medicaid expansion and nonexpansion states as work requirements could improve coverage even more, as would (although uninsured rates are much higher in nonexpansion states congressional proposals that seek to eliminate the Medicaid expansion among all groups, including Asian Americans). Even though the gap with a federal solution.16 This is particularly true in states with coverage gap between white and Asian American adults has been substantial Asian American (and Black) populations, such as Texas, eliminated since the ACA, coverage gains vary among the numerous Florida, and Georgia. Targeted Medicaid expansions to include distinct Asian American subpopulations, and many Asian Americans undocumented populations, such as California’s recent legislation, also remain without health insurance coverage. could have a dramatic impact for Asian Americans in certain states.17 Coverage gains for all Americans have generally stalled since 2016 for Extend and enhance marketplace subsidies. Premium contributions four distinct reasons: for marketplace plans are capped at 2.1 percent to 9.78 percent of income for people between 100 percent and 400 percent of poverty • Lack of Medicaid expansion in 14 states.12 ($26,200 to $104,800 for a family of four in 2020). However, affordability • Affordability barriers in private insurance and particularly continues to be the most often-cited reason why people don’t enroll for people whose income exceeds the eligibility threshold for in coverage through the marketplaces.18 Those who earn above 400 marketplace subsidies (400% of poverty). percent of poverty are not eligible for tax credits and may spend well beyond 9.78 percent of their income on premiums. Extending the upper • Congressional and executive branch actions, including immigration income limit beyond 400 percent of poverty and enhancing subsidies policies that have reduced enrollment in both Medicaid and for those under 400 percent of poverty would provide relief to people marketplace plans. who find their coverage unaffordable.19 commonwealthfund.org Data Brief, July 2020 Gap Closed: The Affordable Care Act’s Impact on Asian Americans’ Health Coverage 10 Provide funding and support for community-based outreach and marketplace navigation assistance HOW WE CONDUCTED THIS STUDY in all states. Previous research has found that This study uses 2010–2018 data from the American Community Survey (ACS) to look at the investing in effective community-based outreach and navigation efforts with cultural and language- percentage of uninsured adults ages 19–64. specific strategies likely increases enrollment in The ACS is a large federal survey conducted by the U.S. Census Bureau that is used to track Medicaid and the ACA marketplaces.20 The Trump demographic characteristics of the U.S. population, including respondents’ insurance administration has dramatically reduced funding coverage status and their primary type of health insurance coverage (for example, employer- for marketplace navigators and advertising since based, Medicaid). The ACS samples approximately 3.5 million individuals each year, with annual 2017, potentially limiting the reach of these groups response rates over 90 percent. The Census Bureau makes approximately two-thirds of ACS to enroll underrepresented populations.21 If funding response records available to researchers in the Public Use Microdata Sample (ACS PUMS). continues to be limited, state policymakers could fund local groups that serve Asian Americans and Analytical Approach other targeted racial and ethnic communities. We stratified survey respondents by their self-reported race or ethnicity: white (non-Hispanic), Continue to collect and analyze Asian American Black (non-Hispanic), Hispanic (any race), Asian American, American Indian/Alaska Native, and subpopulation data. Section 4302 of the ACA Native Hawaiian or Pacific Islander. We also stratified by income categories and specific Asian requires federal data collection efforts to collect American ethnicities: Indian, Chinese, Korean, Filipino, Vietnamese, and other. (Note: A small information on people’s race, ethnicity, and other number of respondents self-identified as having multiple Asian ethnicities. These individuals demographics, with the aim of reducing U.S. health are included in estimates for all Asian Americans, but are not included in exhibits that separate disparities.22 Our analysis shows that there is each ethnicity.) We calculated national rolling two-year averages for the uninsured rate from significant heterogeneity in insurance coverage rates 2010–2011 to 2017–2018 to ensure sufficient sample size, stratified by race and ethnicity. We among different subgroups within the broader Asian also calculated the average annual uninsured rate for Asian American and white adults from American population. Collecting and analyzing 2010–2011 to 2017–2018 across two categories of states: subpopulation data has been noted as an important • The Medicaid expansion group included the 31 states that, along with the District of goal in the past and continues to be critically important to informing policymaking.23 Columbia, had expanded their Medicaid programs under the ACA as of January 1, 2018. • The nonexpansion group comprised the 19 states that had not expanded Medicaid as of January 1, 2018. Maine and Virginia are considered nonexpansion states in this analysis because they both implemented their Medicaid expansions in 2019. Reported values for expansion/nonexpansion categories are averages across survey respondents, not averages of state rates. Estimates derived from the ACS PUMS were suppressed if unweighted cell counts had a relative standard error greater than 30 percent. commonwealthfund.org Data Brief, July 2020 Gap Closed: The Affordable Care Act’s Impact on Asian Americans’ Health Coverage 11 NOTES 1 Jesse C. Baumgartner et al., How the Affordable Care Act Has Narrowed Racial and Virginia implemented Medicaid expansion in 2019 and are considered and Ethnic Disparities in Access to Health Care (Commonwealth Fund, Jan. nonexpansion for this analysis. 2020); Ajay Chaudry, Adlan Jackson, and Sherry A. Glied, Did the Affordable 8 Centers for Medicare and Medicaid Services, “Coverage for Lawfully Present Care Act Reduce Racial and Ethnic Disparities in Health Insurance Coverage? Immigrants,” CMS, n.d. (Commonwealth Fund, Aug. 2019); John J. Park et al., “Health Insurance for Asian Americans, Native Hawaiians, and Pacific Islanders Under the Affordable 9 CMS, “Coverage for Lawfully,” n.d. Care Act,” JAMA Internal Medicine 178, no. 8 (Apr. 30, 2018): 1128–29; John J. Park et al., “Medicaid and Private Insurance Coverage for Low-Income Asian 10 Park et al., ”Health Insurance,” 2018; and Park et al., “Medicaid and Private Americans, Native Hawaiians, and Pacific Islanders, 2010–16,” Health Affairs Insurance,” 2019. 38, no. 11 (Nov. 2019): 1911–17; and Samantha Artiga, Kendal Orgera, and 11 Bureau of Labor Statistics, “Civilian Unemployment Rate,” BLS, U.S. Anthony Damico, Changes in Health Coverage by Race and Ethnicity Since Department of Labor, n.d.; and U.S. Census Bureau, “Nearly 1 in 10 the ACA, 2010–2018 (Henry J. Kaiser Family Foundation, Mar. 2020). Businesses with Employees Are New, According to Inaugural Annual 2 Centers for Disease Control and Prevention, “COVID-19 in Racial and Ethnic Survey of Entrepreneurs,” news release, Sept. 1, 2016. Minority Groups,” CDC, updated June 25, 2020. 12 Oklahoma voters approved Medicaid expansion on July 1, 2020, to go into 3 Gustavo Lopez, Neil G, Ruiz, and Eileen Patten, “Key Facts About Asian effect in 2021. This will leave 13 states without expansion. Americans, A Diverse and Growing Population,” FactTank (blog), Pew 13 Munira Z. Gunja and Sara R. Collins, Who Are the Remaining Uninsured Research Center, Sept. 8, 2017. and Why Do They Lack Coverage? Findings from the Commonwealth Fund 4 Park et al., ”Health Insurance,” 2018; Park et al., “Medicaid and Private Biennial Health Insurance Survey, 2018 (Commonwealth Fund, Aug. 2019); Insurance,” 2019; and Artiga, Orgera, and Damico, Changes in Health and Randy Capps et al., Gauging the Impact of DHS’ Proposed Public- Coverage, 2020. Charge Rule on U.S. Immigration (Migration Policy Institute, Nov. 2018). 5 For premium tax credit eligibility in a given year, the federal poverty 14 Karthick Ramakrishnan and Sono Shah, One “Out of Every 7 Asian Immigrants guidelines from the prior year are applied. Is Undocumented,” Data Bits (blog), APPI Data, updated Sept. 8, 2017. 6 Since the start of 2018, Maine, Virginia, Idaho, and Utah have expanded 15 Based on Medicaid expansion status as of publication date, with Virginia, their Medicaid programs. Maine, Idaho, and Utah included as expansion states; authors’ analysis of U.S. Census Bureau, 2018 1-Year American Community Survey, Public Use 7 Authors’ analysis of U.S. Census Bureau, 2018 1-Year American Community Microdata Sample (ACS PUMS). Although Nebraska and Oklahoma have Survey, Public Use Microdata Sample (ACS PUMS). In this analysis, passed ballot initiatives expanding Medicaid, the expansions have not expansion states are those that expanded Medicaid by January 1, 2018. As of yet taken effect; therefore, for this calculation they are considered to be that date, there were 19 states that had not yet expanded Medicaid. Maine nonexpansion states. commonwealthfund.org Data Brief, July 2020 Gap Closed: The Affordable Care Act’s Impact on Asian Americans’ Health Coverage 12 16 Linda J. Blumberg et al., Comparing Health Insurance Reform Options: From “Building on the ACA” to Single Payer (Commonwealth Fund, Oct. 2019). 17 Alexei Koseff, “California Will Give Health Coverage to Undocumented Young Adults,” San Francisco Chronicle, June 10, 2019. 18 Sara R. Collins and Munira Z. Gunja, What Do Americans Think About Their Health Coverage Ahead of the 2020 Election? Findings from the Commonwealth Fund Health Insurance in America Survey, March–June 2019 (Commonwealth Fund, Sept. 2019). 19 Jodi Liu and Christine Eibner, Expanding Enrollment Without the Individual Mandate: Options to Bring More People into the Individual Market (Commonwealth Fund, Aug. 2018). 20Shanoor Seervai, “Cuts to the ACA’s Outreach Budget Will Make it Harder for People to Enroll,” Commonwealth Fund, Oct. 11, 2017; and Park et al., “Medicaid and Private Insurance,” 2019. 21 Karen Pollitz, Jennifer Tolbert, and Maria Diaz, Data Note: Limited Navigator Funding for Federal Marketplace States (Henry J. Kaiser Family Foundation, Nov. 2019). 22Office of Minority Health, “Improving Data Collection to Reduce Health Disparities,” U.S. Department of Health and Human Services, n.d. 23Chandak Ghosh, “A National Health Agenda for Asian Americans and Pacific Islanders,” JAMA 304, no. 12 (Sept. 22/29, 2010): 1381–82. commonwealthfund.org Data Brief, July 2020 Gap Closed: The Affordable Care Act’s Impact on Asian Americans’ Health Coverage 13 ABOUT THE AUTHORS Healthcare Research and Transformation and the University of Michigan’s Munira Z. Gunja, M.P.H., is senior researcher in the Health Care Center for Value-Based Insurance Design. Mr. Shah holds a master’s Coverage, Access, and Tracking program at the Commonwealth Fund. Ms. degree in public policy from the University of Michigan’s Gerald R. Ford Gunja joined the Fund from the U.S. Department of Health and Human School of Public Policy. Services in the office of the Assistant Secretary for Planning and Evaluation David C. Radley, Ph.D., M.P.H., is senior scientist for the Commonwealth (ASPE), Division of Health Care Access and Coverage, where she received Fund’s Health Care Coverage, Access, and Tracking program, working on the Secretary’s Award for Distinguished Service. Before joining ASPE, Ms. the Scorecard project. Dr. Radley develops national, state, and substate Gunja worked for the National Cancer Institute where she conducted data regional analyses on health care system performance and related analysis for numerous studies featured in scientific journals. She graduated insurance and care system market structure analyses. He is also a senior from Tulane University with a B.S. in public health and international study director at Westat, a research firm that supports the Scorecard development and an M.P.H. in epidemiology. project. Previously, he was associate in domestic health policy for Abt Jesse C. Baumgartner is a research associate in the Health Care Coverage, Associates, with responsibility for a number of projects related to Access, and Tracking program at the Commonwewalth Fund. Before measuring long-term care quality and evaluating health information joining the Fund, he worked as a technology development/licensing technology initiatives. Dr. Radley received his Ph.D. in health policy from manager at Memorial Sloan Kettering Cancer Center, a life sciences the Dartmouth Institute for Health Policy and Clinical Practice, and holds consultant at Stern Investor Relations, and earlier in his career as a reporter a B.A. from Syracuse University and an M.P.H. from Yale University. for the Lewiston Tribune in Idaho. Mr. Baumgartner earned his B.A. in Sara R. Collins, Ph.D., is vice president for Health Care Coverage, Access, journalism and history from the University of North Carolina at Chapel and Tracking at the Commonwealth Fund. An economist, Dr. Collins Hill, where he was elected Phi Beta Kappa, and is currently pursuing his joined the Fund in 2002 and has led the Fund’s national program on health M.P.H. at the CUNY Graduate School of Public Health and Health Policy. insurance since 2005. Since joining the Fund, she has led several national He is also a CFA® charterholder. surveys on health insurance and authored numerous reports, issue briefs, Arnav Shah, M.P.P., is research associate for the Commonwealth Fund’s and journal articles on health insurance coverage and policy. She has research and policy department. In this role, Mr. Shah provides support provided invited testimony before several Congressional committees to a department charged with adding value to the Fund’s work in all of and subcommittees. Prior to joining the Fund, Dr. Collins was associate its core areas. Prior to joining the Fund, Mr. Shah was a research assistant director/senior research associate at the New York Academy of Medicine. in the Health Policy Center of the Urban Institute. From 2011 to 2012 he Earlier in her career, she was an associate editor at U.S. News & World was a health policy intern for the Center on Budget and Policy Priorities, Report, a senior economist at Health Economics Research, and a senior where he researched and wrote on the Affordable Care Act, Medicare, health policy analyst in the New York City Office of the Public Advocate. Medicaid, and CHIP. During graduate school he worked for the Center for Dr. Collins holds a Ph.D. in economics from George Washington University. commonwealthfund.org Data Brief, July 2020 ACKNOWLEDGMENTS The authors thank David Blumenthal, Barry Scholl, Eric Schneider, Elizabeth Fowler, Chris Hollander, Jen Wilson, and Paul Frame, all of the Commonwealth Fund. Editorial support was provided by Maggie Van Dyke. For more information about this brief, please contact: Munira Z. Gunja Senior Researcher, Health Care Coverage, Access, and Tracking The Commonwealth Fund mgcmwf.org About the Commonwealth Fund The mission of the Commonwealth Fund is to promote a high-performing health care system that achieves better access, improved quality, and greater efficiency, particularly for society’s most vulnerable, including low-income people, the uninsured, and people of color. Support for this research was provided by the Commonwealth Fund. The views presented here are those of the authors and not necessarily those of the Commonwealth Fund or its directors, officers, or staff.