US Health Care System Overview

Study Notes

The Affordable Care Act (ACA) enacted in 2010 aims to provide affordable health insurance to all Americans through a shared responsibility model involving the government, employers, and individuals.
The Centers for Medicare and Medicaid Services (CMS) administers Medicare, a federal program for adults aged 65 and older and certain individuals with disabilities.
CMS also collaborates with state governments to administer Medicaid and the Children's Health Insurance Program (CHIP) for low-income populations.
Private health insurance is primarily regulated at the state level.
In 2014, state and federal health insurance marketplaces were established to expand access to private insurance coverage, with income-based subsidies for lower- and middle-income individuals.
States were also given the option of participating in a federally subsidized expansion of Medicaid eligibility.

Private voluntary health insurance (VHI) covered approximately 67.2% of U.S. residents: 55.7% through employer-provided plans and 14.6% through direct purchases.
Public programs covered roughly 37.1% of residents: Medicare (16.3%), Medicaid (19.6%), direct purchase (16.3%), and military coverage (4.7%).

In the first quarter of 2016, 27.3 million individuals were uninsured, representing 8.6% of the population - a decrease from 9.1% in 2015.

The implementation of major ACA coverage expansions in January 2014, including the individual mandate, health insurance marketplaces with subsidies, and Medicaid expansion, increased the share of the population with insurance.
Between 2014 and early 2016, health insurance coverage increased significantly for most racial and ethnic groups, with the largest gains among Hispanics (6.6 percentage points), Asian Americans (4.8 points), non-Hispanic blacks (3.1 points), and non-Hispanic whites (2.4 points).
The ACA is projected to reduce the number of uninsured by 24 million by 2018.

In 2015, over 10 million Americans were eligible for both Medicare and Medicaid.
CHIP, which is either an extension of Medicaid or a separate program in different states, covered over 8.1 million children in low-income families in 2015.

Undocumented immigrants are generally ineligible for public coverage, and nearly two-thirds are uninsured.
Hospitals accepting Medicare funds must provide emergency medical care to stabilize any patient, and several states allow undocumented immigrants to qualify for emergency Medicaid coverage beyond stabilization care.
Some states and local governments offer additional coverage, such as programs for undocumented children or pregnant women.