The ACA increased coverage and access for the chronically ill, but many still face barriers to care

1. Implementation of the ACA was associated with both increased patient checkups and insurance coverage.

2. Despite some improvements in outcomes, a significant number of racial/ethnic minorities continue to lack coverage and access to care.

Evidence Rating Level: Good (2)

Study Rundown: The incidence and prevalence of chronic disease is steadily rising in the United States. This burden of chronic disease frequently falls upon ethnic and racial minorities—a phenomenon closely tied to unequal access to healthcare among such groups. In response, the Patient Protection and Affordable Care Act (ACA) was developed to reduce the number of uninsured Americans and improve access to care. However, little is currently known regarding the extent to which the ACA increases coverage or access to care for adults with chronic medical conditions. The authors of this study aimed to assess whether the ACA was associated with expanded insurance coverage and access to care. Additionally, they investigated whether preexisting racial and ethnic inequalities were reduced. This study has several limitations. First, data was collected via a self-reported telephone survey, excluding those without telephones. Second, data was only examined from the first year of the ACA’s major coverage expansion provisions. Overall, the authors concluded that while the ACA increased coverage and access for the chronically ill, significant gaps in healthcare access persist, especially for minority populations. These results suggest that other interventions beyond the ACA are required to tackle persisting barriers to healthcare.

Click to read the study, published today in the Annals of Internal Medicine

Relevant Reading: The Affordable Care Act, Five Years Later: Policies, Progress, and Politics

In-Depth [retrospective cohort]: In this study, data was collected from the Behavioural Risk Factor Surveillance System (BRFSS). Overall, 606 277 adults aged 18 to 64 years with a chronic disease were included. The primary outcomes assessed were the proportions of respondents with insurance coverage, having a personal physician, having had a routine checkup in the past 12 months, and forgoing a needed physician visit due to cost. These outcomes were compared pre versus post-ACA implementation. Additionally, epidemiological data was acquired (e.g., marital status, race/ethnicity). It was observed that insurance coverage increased by 4.9 percentage points (95%CI, 4.4 to 5.4) following ACA implementation. Having a checkup also increased by 2.7 percentage points (CI, 2.2 to 3.4), while having a personal physician did not change significantly. Despite improvements, one fifth of black patients and one third of Hispanic patients continued to face gaps in healthcare post ACA implementation. These gaps were most significant in Medicaid nonexpansion states.

Image: PD

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