A recent Commonwealth Fund analysis found that the Affordable Care Act coverage gains are beginning to recede, largely due to actions taken by the Administration and Congress in the past year. Four million working age adults have lost coverage since 2016. The increase in the uninsured rate was higher for people earning less than 250% of federal poverty (about $30,000 for an individual and $61,000 for a family of four).

Commonwealth cited two major factors for coverage declines: 1) lack of federal legislative actions to improve specific weaknesses in the ACA and 2) actions by the current administration that have exacerbated those weaknesses. Congress could act to bolster the individual market and increase awareness of coverage options, but it is unclear whether bipartisan support is available. Without intervention, this trend will continue and is expected to worsen with the elimination of the requirement for insurance coverage (individual mandate).