Most Americans rely on health insurance to help pay for their health care. And most who are younger than age 65 obtain coverage through the private insurance market.
The majority of people age 50–64 have health insurance coverage through their employer. However, the share of people with such coverage has been declining. Prior to the 2010 Affordable Care Act (ACA), people age 50–64 often had difficulty obtaining health care coverage if they did not have access to it through their employer. The ACA has provided new opportunities for health coverage for this population through health insurance benefit exchanges known as marketplaces. It has also provided expanded coverage through Medicaid (see also Expansion of Health Care Coverage).
Some Americans have private retiree health coverage through former employers. In addition, many beneficiaries in Traditional Medicare purchase private Medicare Supplement, also known as Med Supp or Medigap, policies to supplement their Medicare coverage.
Historically, the primary goals of health care reform efforts have been to ensure that everyone has access to affordable health care coverage and to provide adequate protection from health care costs. Reform efforts have included changes to the practices of private insurers.