To gauge the perspectives of Americans on the marketplaces, Medicaid and other health insurance issues, the Commonwealth Fund Affordable Care Act Tracking Survey interviewed a random, nationally representative sample of 2,410 adults ages 19 to 64 between Nov. 2 and Dec. 27, 2017, including 541 people who have marketplace or Medicaid coverage.

This survey, along with other recent federal and private surveys, indicates that gains in coverage post-ACA have leveled out, and uninsured rates may even be ticking up slightly. Findings suggest policy changes could increase coverage, including greater outreach and advertising in all states and reforms to improve plan affordability.

Significant findings include:

• 14 percent of working age adults were uninsured at the end of 2017, unchanged from March–June 2017
• 35 percent of uninsured adults were not aware of the marketplaces
• Among uninsured adults who were aware of the marketplaces but did not plan to visit them, 71 percent said they didn’t think they could afford health insurance while 23 percent thought the ACA was going to be repealed, and
• About three in 10 people with marketplace coverage or Medicaid said they were not confident they would be able to keep their coverage in the future. Of those, 47 percent said they felt this way because either the Trump Administration would not carry out the law (32 percent) or Congress would repeal it (15 percent).