The Affordable Care Act has improved key health care indicators for millions of Americans, reversing what had been a downward spiral in which health care was becoming more costly and less available to many Americans, a new study finds.
The findings, published in the Journal of the American Medical Association, show marked gains in the number of people with insurance—as other research has repeatedly confirmed—as well as improved access to doctors and medications, affordable health care and good health status after implementation of the Affordable Care Act, aka ‘Obamacare’.
In particular, minority groups and the chronically ill have made huge strides in gaining health coverage and getting the care they need, the researchers reported. Low-income Americans also experienced significant gains in coverage and access to health care, with the most striking improvements found in states that expanded their Medicaid programs under the ACA to include more poor people.
The improvements nationwide came after all six measures used in the study “showed worsening trends in the 2012-13 period, particularly between March 2013 and September 2013,” according to the study, which looked at the experiences of about 500,000 adults age 18 to 64.
All but one of those measures—days limited by poor health—improved significantly after Obamacare plans went on sale on government-run exchanges in October 2013, according to the study. Here’s the breakdown of the indicators:
- The number of people who lacked health insurance fell by 7.9 percentage points
- The number of people who reported being unable to afford care fell by 5.5 percentage points, translating into 11 million more people who can afford care.
- The number of people who lacked a personal physician fell by 3.5 percentage points.
- The number of people who said they were just in fair or poor health fell by 3.4 percentage points.
- The number of people who lacked easy access to medicine fell by 2.4 percentage points.
For the category of days limited by poor health, the downward trend of people reporting that measurement stopped getting worse after the ACA went into effect, but it did not get significantly better as did the other measurements, the study found.
Largest improvements found among racial and ethnic minorities
What’s particularly important, the researchers say, is that “the largest improvements in access to coverage occurred among racial and ethnic minorities,” who have historically faced higher rates of uninsurance and poor access to quality health care.
While whites saw their uninsured rates drop by 6.1 percentage points, there was an 11.9 percentage point decrease in the number of uninsured Latinos. The number of non-Latino blacks without health coverage decreased by 10.8 percentage points after the ACA went into effect, the study found.
Blacks and Hispanics were a specific target of the Obama administration in its rollout of the health-care law, given their disproportionately low insurance rates and limited access to health care. On a larger scale, reducing health disparities, including racial disparities, is a central goal of health care reform — and according to the researchers, these latest findings show “that the ACA may be associated with reductions in long-term disparities in access to care.”
Addressing racial disparities in health care would have massive implications, even beyond improving the health of millions of Americans. A 2009 study from George Washington University estimated that eliminating racial disparities in health would reduce direct medical care expenditures by nearly $100 billion annually.
Findings are ‘very consistent with what health policy experts predicted’
As the researchers note, this type of observational study can’t prove that all of these positive changes are a direct result of the ACA’s coverage expansions, and it’s possible that other factors played a role. But, they added that the analysis adjusted for several potential confounding factors, including income, individual employment and state unemployment rates. Additionally, the analysis that looked at the differences in Medicaid expansion states “represents a stronger research design because it included a [natural] control group” of states that did not expand Medicaid, the authors note.
So although the researchers can’t entirely rule out other influences on insurance status and health care access, the evidence is strong enough to conclude that the ACA is the primary driving force behind the observed improvements — in other words, the health care law is doing exactly what it was designed to do.
In fact, the new findings are “very consistent with what health policy experts predicted,” Dr. John Rowe, a health policy professor at the Columbia University’s Mailman School of Public Health in New York, told Reuters news agency. “If you give people insurance, they use it. And people who get more care do better than people who don’t.”
The study comes a month after a major U.S. Supreme Court decision ensured that federal subsidies that help most Obamacare customers pay for their health insurance plans remain available in every state, and not just in the District of Columbia and the 13 states that are operating their own marketplaces. It also comes slightly more than three months before the start of Obamacare’s third open enrollment season on Nov. 1.
In the most recent open enrollment period, which ended in February, about 10.2 million Americans enrolled in private health plans sold on Obamacare exchanges. Another 12.2 million extra people have been covered by Medicaid and the Children’s Health Program since the ACA was implemented, according to the latest data from the U.S. Department of Health and Human Services.
Medicaid expansion states faring better
As of this month, 29 states and the District of Columbia have expanded Medicaid to cover, typically at no charge to enrollees, nearly all adults whose household income is less than 138 percent of the federal poverty level, or $16,242 for a single person in most states. For the first three years of expansion, the federal government is footing 100 percent of the bill for the newly eligible in such states, and then has committed to funding no less than 90 percent of their costs in perpetuity.
States that have expanded Medicaid have seen bigger overall reductions in the number of low-income people who lack insurance and personal physicians, and who have difficulty accessing medicine than did the states that did not expand their Medicaid programs, which are jointly run with the federal government, the study found. Experts have warned that Republican governors’ refusal to expand Medicaid puts low-income Americans “at risk of more serious health conditions.”
States that expanded Medicaid saw the uninsured rate among low-income adults drop by 5.2 percentage points more than non-expansion states, according to the study. The drop in the number of adults who had no personal doctor was 1.8 percentage points better in expansion states than non-expansion state, and 2.2 percentage points greater than non-expansion states when measuring the number of low-income earners who had no easy access to medicine.
“As states continue to debate whether to expand Medicaid under the ACA, these results add to the growing body of research indicating that such expansions are associated with significant benefits for low-income populations,” the study’s authors advise.
The ACA, as of 2014, required that most Americans have some sort of health coverage or pay a fine.
To expand coverage, the law mandated that adult children be allowed to stay on their parents’ health plan until age 26, authorized the creation of health insurance marketplaces to offer subsidized plans, and authorized states to expand their Medicaid programs to cover, usually at no direct cost to enrollees, nearly all people who earn less than 138 percent of the federal poverty level.