As originally signed into law, the Affordable Care Act (ACA) expanded Medicaid to all individuals with family incomes at or below 138 percent of the federal poverty level (FPL). In this brief, we examine patterns of pre-reform health care access and affordability within the ACAs adult Medicaid target population, more than 40 percent of whom were uninsured at the time of the survey. Specifically, we focus on comparing the adults in this income group who had Medicaid or other public coverage at the time of the survey and were continuously insured for the entire prior year with those who were uninsured all or part of the prior year. Although these comparisons are not intended to show the impact of public coverage on previously uninsured adults, they do show the gaps in access and affordability before the ACA and suggest the potential gains to this population from enrolling in Medicaid.

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