Related: Why use ACA exchanges?

Or, as Commonwealth puts it in a review of its findings: “As of February-April 2016, of the estimated 24 million uninsured adults, 88 percent — approximately 21 million — had incomes less than 138 percent of poverty, were young adults under age 35, were Latino, and/or were working in small firms.”

The Latino portion of the 24 million does pop out a bit. As more people have acquired coverage, the Latino percentage of the uninsured has increased substantially, from 29 percent in 2013 to 40 percent in the most recent survey.

When age was removed as a factor, and the uninsured were viewed through the lens of income, the survey found that the percent of those without coverage who earned less than 138 percent of the poverty level fell from 35 percent to 24 percent.

The decrease among young adults ages 19-35 in that income category was impressive as well, dropping from 28 percent to 18 percent. Blacks in that catergory without coverage fell from 21 percent to 13 percent. Latinos in that range reported the lowest decrease: 36 percent to 29 percent.

Other factors

Commonwealth noted that many among the uninsured qualify by income for subsidized insurance, but face various obstacles to obtaining it. The very complexity of the system currently in place probably discourages some from obtaining coverage. And because Medicaid expansion is as yet incomplete, many can’t access coverage.

“One-third (34%) of adults who were uninsured in 2016 have Medicaid-eligible incomes but live in one of the 20 states that had not yet expanded eligibility for Medicaid at the time of the survey,” Commonwealth reported. “This includes adults who fall into the so-called coverage gap — that is, those with incomes under 100 percent of poverty who are neither eligible for their state’s existing Medicaid program nor marketplace subsidies (22%) — and those with incomes between 100 percent and 138 percent of poverty who are eligible for marketplace subsidies (12%).”

Among the major issues cited by the report that need to be addressed to make coverage available to more Americans:

• The ACA’s exclusion of undocumented immigrants from the coverage expansions.

• The lack of Medicaid expansion in 19 states, including two of the nation’s largest states.

• Less awareness of the marketplaces in some demographic groups.

• Concerns about plan affordability and subsidy eligibility.

• Difficulty selecting plans during the enrollment process.

• Lack of assistance in selecting plans.

The bottom line, the report said, is that coverage will continue to be inaccessible to millions until a smoother, more consistent health system emerges.