A new study details amazing improvements in the medical care and health of low-income American adults as a result of the health coverage expansions from the Affordable Care Act, also known as Obamacare or the ACA.
The Affordable Care Act’s health coverage expansions have produced major improvements in medical care and health for low-income adults.
These improvements include reduced out-of-pocket spending, better access to primary care and preventive services, improved self-reported health, and improved care for those with chronic conditions.
This news is according to a new study from Harvard T.H. Chan School of Public Health, and it provides the most up-to-date assessment yet of the ACA.
The Affordable Care Act is a comprehensive health care reform law enacted in March 2010 under the leadership of President Barack Obama. It is sometimes known as ACA, PPACA, or “Obamacare”.
The law has 3 primary goals:
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1. Make affordable health insurance available to more people. The law provides consumers with subsidies (“premium tax credits”) that lower costs for households with incomes between 100% and 400% of the federal poverty level.
2. Expand the Medicaid program to cover all adults with income below 138% of the federal poverty level. (Not all states have expanded their Medicaid programs.)
3. Support innovative medical care delivery methods designed to lower the costs of health care generally.
“With Congress debating major changes to the Affordable Care Act, especially for people on Medicaid and with pre-existing conditions, it’s critical for policymakers to understand what’s at risk. Our study shows that the ACA continues to improve medical care and health among low-income patients and those with chronic illnesses,” said Benjamin Sommers, associate professor of health policy and economics at Harvard Chan School and lead author of the study.
Researchers looked at survey data from low-income adults in three states: Kentucky, which expanded Medicaid under the ACA; Arkansas, which expanded private insurance to low-income adults using the federal marketplace; and Texas, which did not expand coverage.
Prior to the ACA, each of the three states had similar uninsured rates among low-income adults, around 40%.
By the end of 2016, the uninsured rate in Kentucky and Arkansas, the two states that expanded coverage, had dropped by more than 20 percentage points relative to Texas — the rate was 7.4% in Kentucky, 11.7% in Arkansas, and 28.2% in Texas.
Among those who gained insurance coverage, there was a 41 percentage-point increase in having a usual source of care, a $337 reduction in annual medical out-of-pocket spending, significant increases in preventive health visits and glucose testing, and a 23 percentage-point increase in “excellent” self-reported health.
People with chronic illnesses such as diabetes, heart disease, and asthma also fared better after gaining coverage through Medicaid or the federal marketplace health plans. They reported improvements in affordability of care, regular care for their conditions, medication adherence, and self-reported health.
The authors noted that the improvements in health care have continued to grow over the three years of the ACA’s coverage expansions, and that the improvements occurred whether states expanded Medicaid (as in Kentucky) or private insurance (as in Arkansas), showing that both are effective ways to help lower-income Americans.
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Key takeaways from this study:
1. Low-income adults have seen major improvements in their medical care and health as a result of the Affordable Care Act’s health coverage expansions.
2. Key improvements for people who obtained health coverage under Medicaid or through the federal insurance marketplace included reduced out-of-pocket spending, better access to primary care and preventive services, and improved self-reported health.
3. People with chronic conditions — a vulnerable and high-cost population–have also fared better under the ACA, with more affordable care, more regular care for their conditions, better adherence to their medications, and better self-reported health.
Other Harvard Chan School authors of the study included Bethany Maylone, Robert Blendon, E. John Orav, and Arnold Epstein. Funding for the study came from the Commonwealth Fund and in part from the Agency for Healthcare Research and Quality, grant number K02HS021291.
Related Journal Article: “Three-Year Impacts of the Affordable Care Act: Improved Medical Care and Health Among Low-Income Adults,” Benjamin D. Sommers, Bethany Maylone, Robert J. Blendon, E. John Orav, Arnold M. Epstein, Health Affairs, June 2017, doi: 10.1377/hlthaff.2017.0293
Source: Harvard T.H. Chan School of Public Health
Journal: Health Affairs
Funder: Commonwealth Fund, Agency for Healthcare Research and Quality