More than half of Americans who purchased health insurance through a public exchange were uninsured just prior to obtaining coverage.

New data from the Kaiser Family Foundation found that 57% of those who purchased coverage were previously uninsured, while 14% were covered by an employer/COBRA plan, 16% covered by a different non-group plan and 9% by Medicaid or another public program. A March 30 Los Angeles Times article using data from RAND Corp. and the newspaper’s analysis had estimated the number of uninsured who gained coverage at about 33%.

Of the uninsured, most had been without coverage for at least two years, with 72% deciding to buy their own health insurance because of the Affordable Care Act, Kaiser says. Nearly three-quarters (72%) reported they were uninsured because they couldn’t afford health care or had no access to employer-sponsored coverage.

In early June, Gallup reported that 13.4% of all Americans lacked health insurance, down from 17.1% in the first quarter of 2013. It was the lowest recorded level since the polling first began in 2008.

"There has been considerable debate about how many people signing up for coverage in the new exchanges were uninsured,” says Kaiser Foundation President and CEO Drew Altman. “Our survey reveals that the majority of people who enrolled in the new exchanges were previously uninsured.”

See also: Emergence of single-carrier model expected in private HIX

Of those newly insured, a third say they feel vulnerable to high medical bills, with new-found worries about unexpected medical costs rather than concerns about routine care. Nearly half (46%) feel not or not at all confident about having enough money or insurance to pay for a major illness or injury.

Further, 43% of those with ACA-compliant plans say it is very or somewhat difficult for them to pay their monthly premiums, despite 46% of people reporting received some financial help from the government to pay their premiums. That is substantially lower than Department of Human and Human Services data which suggests that 85% of those selecting a plan are eligible for a subsidy, Kaiser notes. “It is likely that at least some individuals receiving government financial help may be unaware that the government is paying a portion of their premium,” the study says.

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