1. This study found improvements in self-reported trends in insurance coverage, primary care access, affordability of healthcare, access to medicine, health and health related limitations when compared to trends in these areas prior to implementation of the Affordable Care Act (ACA).
2. When comparing states that expanded Medicaid with those that did not, this study noted improvements in self-reported insurance coverage and access to primary care and medicines for low-income adults in states that expanded Medicaid.
Evidence Rating Level: 3 (Average)
Study Rundown: When the ACA was enacted in March 2010 it aimed to expand insurance coverage and improve affordability. This study utilized survey data to compare trends in health care coverage, access, and health status prior to ACA implementation to trends following the first two ACA open enrollment periods, the most recent of which was completed in February 2015. This study found improvements in the six measured trends related to health care coverage, access, and health status, and found that changes in insurance coverage and medication access following ACA implementation were greater among minorities than among white adults. This study also compared insurance coverage of low-income adults in states that expanded Medicaid with those that did not and found that low-income adults in states that expanded Medicaid reported greater improvements in insurance coverage and health care access.
The major limitation of this study is its reliance on self-reported survey data, particularly due to the low response rate for this telephone survey and due to the general potential for recall bias inherent to a survey-based research design. However, the study did attempt to account for confounding factors by adjusting for income, employment status, and the state unemployment rate and did include a control group for the portion of the study examining Medicaid expansion. While future research is necessary to corroborate the findings of this study, the current results indicate numerous positive effects from ACA implementation thus far.
Relevant Reading: Health reform and changes in health insurance coverage in 2014
In-Depth [survey]: This survey study utilized data from 507,055 adults gathered between January 1, 2012 to March 31, 2015 using the Gallup-Healthways Well-Being Index (WBI) telephone survey. Six trends related to coverage, access, and health were examined: insurance coverage status, primary care access, access to medications, affordability of medical care, health status, and limitations related to health status. All 6 trends were noted to worsen prior to ACA implementation, with post-ACA trends demonstrating a 7.9% (95% CI, -9.7 to -6.7) improvement in insurance coverage, 3.5% improvement in primary care access (95% CI, -4.6 to -2.2), 2.4% improvement in access to medicine (95% CI, -3.3 to -1.5), 5.5% improvement in affordability of medical care (95% CI, -6.7 to -4.2), 3.4% improvement in health status (95% CI, -4.6 to -2.2), and a 1.7% improvement in limitations imposed by health status (95% CI, -2.4 to -0.9). A 5.2% improvement in insurance coverage (95% CI, -7.9 to -2.6, p<.001), 2.2% improvement in access to medicine (95% CI, -3.8 to -0.7, p=.005) and a 1.8% improvement in primary care access (95%CI, -3.4 to -0.3, p=.02) was noted among low-income adults in states that expanded Medicaid versus low-income adults in states that did not.
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