ACA improved certain outcomes, increased utilization among previously uninsured
For people who qualify for subsidies to buy health coverage under the Affordable Care Act (ACA), the law led not only to expansions in the insured population but better access to care and more diagnoses of conditions like hypertension and high cholesterol.
The study, led by Harvard Medical School clinical fellow Anna Lise Goldman, MD, and published in Health Affairs, used national, longitundal data on 9,653 adults, comparing adults who had gone at least six months without insurance prior to the ACA’s exchanges opening to those who had been continuously insured on employer-sponsored plans. Outcomes were then measured in 2014 after the ACA was implemented.
Goldman and her colleagues found “a range of positive impacts” for the previously uninsured population: the uninsured rate dropped 11 percentage points, the number reporting they were unable to access necessary care dropped 2 percentage points and one in 14 received a new diagnosis of high blood pressure. There were also shifts in utilization, as the previously uninsured group had one more outpatient visit and two additional prescriptions filled in 2014, while probability of a hospital stay jumped by 2.5 percentage points.
“This was the group that policymakers intended to target with the ACA’s marketplace subsidies,” Goldman said in a Harvard Medical School blog. “Our study shows that the ACA succeeded in improving outcomes for this vulnerable population.”
The gains were particularly concentrated among the lower-income, subsidy-eligible population, with incomes of between 138 percent and 250 percent of the federal poverty level. For example, this subgroup saw bigger increases in number of prescription fills (just under four per year), hypertension diagnosis (up 6.1 percentage points) and diagnosis of high cholesterol (up 5.67 percentage points).
Goldman and her coauthors concluded this showed initial challenges in rolling out the ACA exchanges didn’t hamper all its promised benefits on outcomes and insurance coverage. Some measures, however, didn’t show any improvement, like total spending, preventive health measures and self-reported health. Whether that’s the result of looking at only a single post-ACA year or an indication ACA exchange coverage isn’t as effective in improving those outcomes as Medicaid expansion will be up to future research to determine, Goldman and her coauthors wrote.
“We identified several notable improvements in healthcare access and use that previously uninsured adults experienced,” the researchers concluded. “These benefits were larger for low-income adults, who were eligible to receive cost-sharing reductions. The Trump administration’s decision to cease payments for cost-sharing subsidies to insurers, as well as the elimination of the individual mandate penalty, could further erode marketplace coverage and undo some of these gains.”
John joined TriMed in 2016, focusing on healthcare policy and regulation. After graduating from Columbia College Chicago, he worked at FM News Chicago and Rivet News Radio, and worked on the state government and politics beat for the Illinois Radio Network. Outside of work, you may find him adding to his never-ending graphic novel collection.