An estimated 20 million people have obtained health insurance coverage as a result of the Affordable Care Act (ACA). That increase has brought the country's uninsured rate down to a record low of 8.6%-the lowest in the nation's history. This achievement is impressive, but it's important to look beyond these numbers to get the full picture of the current state of the uninsured; potential obstacles to enrolling them in coverage; and the challenges many providers may face going into 2017.

The U.S. Department of Health and Human Services estimates 27.2 million nonelderly people remain uninsured. In 2014 hospitals provided an estimated $42.8 billion in uncompensated care, according to the American Hospital Association. The presence of an uninsured population and the reality of uncompensated care is nothing new, but the opportunities and challenges to managing both have evolved.

With millions more people now eligible for some type of assistance to obtain coverage, either through Medicaid expansion or subsidies to purchase marketplace coverage, the risk has never been greater that an uninsured patient is eligible for assistance but not taking advantage of it.

A recent report from the Kaiser Family Foundation reveals more:

  • It's estimated that 43% of the uninsured-or 11.7 million people-are eligible for assistance.
  • That means for every 10 people currently uninsured, roughly four of them are missing out on assistance to obtain coverage.
  • 3.8 million of the uninsured (14%) are adults who are eligible for Medicaid.
  • 5.3 million of the uninsured (19%) are individuals eligible for premium tax credits to purchase health coverage through the marketplace.

So why aren't these individuals taking advantage of the assistance available to them? Not surprisingly, lack of knowledge about assistance options, the complexity of the health care system, and concerns regarding affordability are the key drivers.

  • A majority of people eligible for assistance simply are not aware of their eligibility. In fact, 52% of uninsured adults are unaware financial assistance is available through the marketplace, according to the Commonwealth Fund. What's more, 5.2 million people who purchase coverage outside of the marketplace would actually be eligible for premium tax credits to purchase coverage if they did so through the marketplace.
  • There is a common perception that health care coverage will be too costly. The rising cost of premiums has been a recent trend in the news, likely further fueling this perception among consumers. Yet the HHS estimates that, once subsidies have been taken into account, most people who obtain coverage on the marketplace will be able to find a plan for less than $75 a month.

While the root of these challenges is not new, the factors influencing each have evolved. This continued evolution of the state of the uninsured and assistance options available means your patient financial management strategy cannot employ a "set it and forget it" approach. It is important to build a strategy that has the flexibility to evolve with the industry. Equally as important is committing to evaluate your strategy on a regular basis to identify opportunities for improvement.