7
This count includes the District of Columbia as a state and excludes Missouri and Oklahoma, which have approved but
not yet implemented Medicaid expansion under the ACA. The other non-expansion states are Alabama, Florida, Georgia,
Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin, and Wyoming. See Kaiser
Family Foundation, State Health Facts, Status of State Action on the Medicaid Expansion Decision, available at
https://www.kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-
act/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D (downloaded
February 4, 2021).
8
Estimates of nongroup coverage are higher in the American Community Survey than in other data sources. Turner, J.,
and M. Boudreaux. "Health Insurance Coverage in the American Community Survey: A Comparison to Two Other Federal
Surveys." National Academies Press. 2010.
9
Uberoi, N et al. Health Insurance Coverage and the Affordable Care Act, 2010-2016. HHS ASPE Brief, March 3, 2016.
Accessed at: https://aspe.hhs.gov/system/files/pdf/187551/ACA2010-2016.pdf
.
10
Garfield, R. et al. The Uninsured and the ACA: A Primer – Key Facts about Health Insurance and the uninsured amidst
Changes to the Affordable Care Act. Kaiser Family Foundation, January 25, 2019. Accessed at:
https://www.kff.org/racial-
equity-and-health-policy/issue-brief/changes-in-health-coverage-by-race-and-ethnicity-since-the-aca-2010-2018/.
11
Analysis of Recent Declines in Medicaid and CHIP Enrollment. Kaiser Family Foundation, November 25, 2019. Accessed
at: https://www.kff.org/medicaid/fact-sheet/analysis-of-recent-declines-in-medicaid-and-chip-enrollment/
.
12
Broaddus, M. (2019). Research Note: Medicaid Enrollment Decline Among Adults and Children Too Large to Be
Explained by Falling Unemployment. Center on Budget and Policy Priorities.
13
Pollitz et al. Limited Navigator Funding for Federal Marketplace States. Kaiser Family Foundation, November 2019.
Accessed at:
https://www.kff.org/private-insurance/issue-brief/data-note-further-reductions-in-navigator-funding-for-
federal-marketplace-states/; Tolbert, J. et al. Impact of Shifting Immigration Policy on Medicaid Enrollment and Utilization
of Care among Health Center Patients. Kaiser Family Foundation, October 2019. Accessed at:
https://www.kff.org/medicaid/issue-brief/impact-of-shifting-immigration-policy-on-medicaid-enrollment-and-utilization-
of-care-among-health-center-patients/.
14
Health Management Associates. COVID-19 Impact on Medicaid, Marketplace, and the Uninsured, May 2020. Accessed
at:
https://www.healthmanagement.com/wp-content/uploads/HMA-Updated-Estimates-of-COVID-Impact-on-Health-
Insurance-Coverage-May-2020.pdf; Dorn, S. The COVID-19 Pandemic and Resulting Economic Crash Have Caused the
Greatest Health Insurance Losses in American History, July 17, 2020. Families USA Accessed at:
https://familiesusa.org/wp-content/uploads/2020/07/COV-254_Coverage-Loss_Report_7-17-20.pdf;
Garfield, R., et al. Eligibility for ACA Health Coverage Following Job Loss, May 13, 2020. The Kaiser Family Foundation.
Accessed at: https://www.kff.org/coronavirus-covid-19/issue-brief/eligibility-for-aca-health-coverage-following-job-loss/
;
Garrett, B and Gangopadhyaya, A. How the COVID-19 Recession Could Affect Health Insurance Coverage, May 4, 2020.
The Urban Institute. Accessed at:
https://www.urban.org/research/publication/how-covid-19-recession-could-affect-
health-insurance-coverage; Banthin J., Simpson, M., Buettgens, M., Blumberg, L., and Wang, R. Changes in health
insurance coverage due to the COVID-19 recession: Preliminary estimates using microsimulation. Urban Institute. July 13,
2020. Accessed at:
https://www.urban.org/research/publication/changes-health-insurance-coverage-due-covid-19-
recession.
15
Sara R. Collins, Herman K. Bhupal, and Michelle M. Doty. Health Insurance Coverage Eight Years After the ACA: Fewer
Uninsured Americans and Shorter Coverage Gaps, But More Underinsured — Findings from the Commonwealth Fund
Biennial Health Insurance Survey, 2018. February 2019. The Commonwealth Fund. Accessed at:
https://www.commonwealthfund.org/sites/default/files/2019-02/PDF_Collins_2018_biennial_topline_exhibits.pdf
.
16
Collins, S., Gunja, M., and Aboulafia, G. U.S. Health Insurance Coverage in 2020: A Looming Crisis in Affordability. August
19, 2020. Accessed at:
https://www.commonwealthfund.org/publications/issue-briefs/2020/aug/looming-crisis-health-
coverage-2020-biennial.
17
Estimates from the Household Pulse Survey are not directly comparable to estimates from NHIS or ACS due to
differences in methodology. For example, “don’t know” or missing survey responses are imputed in the NHIS and ACS
data, but not in the Pulse data, and the Household Pulse Survey estimates do not include children. U.S. Census Bureau.
Household Pulse Survey Data Tables. January 23, 2021. Accessed at:
https://www.census.gov/programs-
surveys/household-pulse-survey/data.html.
Centers for Diseases Control and Prevention, National Center for Health Statistics. Health Insurance Coverage, Household
Pulse Survey. January 27, 2021. Accessed at: https://www.cdc.gov/nchs/covid19/pulse/health-insurance-coverage.htm