The share of Americans under age 65 with employer-sponsored health insurance (ESI) declined every year from 2000-10, a total of 10.6 percentage points. This erosion of ESI, especially among children, would have been much worse if not for public insurance (i.e., Medicaid and CHIP particularly for this group). While children experienced greater losses in ESI than adults, their insured rate actually rose. This rise in insurance was made possible by a 13.7 percentage-point increase in the share of children with public coverage, which was large enough to fully offset their ESI losses. The share of adults with public coverage increased 5.0 percentage points over this period, not nearly enough to offset their ESI loss of 10.1 percentage points.

Because of the Affordable Care Act, more than 30 million people (primarily adults) will get health insurance in coming years that would not have received it—making them more likely to get needed medical care and less likely to come under severe financial distress when they do. In essence, the ACA provides a more inclusive health insurance safety net.