Access To Care And Affordability Have Improved Following Affordable Care Act Implementation; Problems Remain

Abstract

There is growing evidence that millions of adults have gained insurance coverage under the Affordable Care Act, but less is known about how access to and affordability of care may be changing. This study used data from the Health Reform Monitoring Survey to describe changes in access and affordability for nonelderly adults from September 2013, just prior to the first open enrollment period in the Marketplace, to March 2015, after the end of the second open enrollment period. Overall, we found strong improvements in access to care for all nonelderly adults and across income and state Medicaid expansion groups. We also found improvements in the affordability of care for all adults and for low- and moderate-income adults. Despite this progress, there were still large gaps in access and affordability in March 2015, particularly for low-income adults.

Early Effects of the Affordable Care Act on Health Care Access, Risky Health Behaviors, and Self-Assessed Health

“…Shartzer et al (2015), Polsky et al (2015), Kirby and Vistnes (2016), Sommers et al (2015), and Sommers and Blendon et al (2016) show that the timing of the ACA coincided with increased access to care, while Sommers et al (2015) also document an improvement in self-assessed health. However, it is unclear whether estimates based only on time-series variation are able to disentangle causal effects of the ACA from other national shocks.…”

Changes in Utilization and Health Among Low-Income Adults After Medicaid Expansion or Expanded Private Insurance

“…1,3,[11][12][13] Beyond coverage and access, research to date has demonstrated limited impact of the Medicaid expansion on utilization, preventive care, and health. However, coverage expansions can take several years to reach full enrollment, 14 so there is a critical need for longerterm studies.…”

Red-State Medicaid Expansions — Achilles’ Heel of ACA Repeal?

“…) as Simon, Soni, and Cawley (2016) and Wherry and Miller (2016), document that gains in access to care have been largest in states that expanded their Medicaid programs. Similarly, Shartzer, Long, and Anderson (2016) find that low-and moderate-income adults, who saw the largest coverage gains, also saw the largest improvements in access to care.…”

“…Researchers using other survey data sources have documented similar sharp improvements in access to care as the ACA's coverage provisions have taken effect. For example, examining data through March 2015, Shartzer, Long, and Anderson (2016) report that the share of non-elderly adults with a usual source of care and the share who received a routine checkup in the last 12 months has risen alongside insurance coverage, while the share reporting problems accessing care or forgoing care due to cost has fallen. Examining a similar time period, Sommers et al (2015) report reductions in the share of non-elderly adults reporting that they lack easy access to medicine, lack a personal physician, or are unable to afford care.…”

“…Research using survey data show that the share of families reporting problems paying medical bills has fallen substantially since 2013, with particularly large reductions for low-and moderate-income adults (Shartzer, Long, and Anderson 2016). Studies using data from consumer credit reports to compare states that have and have not expanded Medicaid found similar improvements in financial security, including reductions in the amount of debt sent to a collection agency and improvements in credit scores (Dussault, Pinkovskiy, and Zafar 2016;Hu et al 2016).…”