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Since the Affordable Care Act took effect, fewer Americans lack health insurance or have trouble getting the care and medicines they need, a study released Tuesday says.
The research, published in the Journal of the American Medical Association, says the number of Americans who reported being uninsured dropped 7.9 percentage points by the first quarter of this year. Minorities saw the biggest reductions — with uninsured rates among Latinos, for example, dropping by 11.9 percentage points.
“The ACA may be associated with reductions in longstanding disparities in access to health care,” says Benjamin Sommers of the Harvard T.H. Chan School of Public Health, who led the study while an adviser to the U.S. Department of Health and Human Services.
Sommers and his colleagues analyzed 2012-15 results of the Gallup-Healthways Well-Being Index, a national telephone survey, and examined changes among 507,055 U.S. adults ages 18-64. Pre-ACA was defined as January 2012-September 2013, post-ACA as January 2014-March 2015.
“By the first quarter of 2015, the adjusted proportion of adults who were uninsured decreased by 7.9 percentage points; which, based on Census estimates, is equivalent to 15.8 million adults gaining coverage,” Sommers says.
The study also found improvements in other measures of health care access — a 3.5 percentage-point drop in those saying they had no personal physician; a 2.4 percentage-point drop in those reporting “no easy access to medicine” and a 5.5 percentage-point drop in those saying they couldn’t afford care.
Researchers note that the design of the study makes it impossible to know whether these changes are solely and directly related to the ACA. Although they controlled for factors such as income and state unemployment rates, they acknowledge the economic recovery may have played a part in improvements.
Avik Roy, a health care policy expert with the free market Manhattan Institute, says the economy is a very significant factor. “As more people go back to work, you’re going to see a reduction in the uninsured rate,” he says. “For the under-65 population, the route to the best quality health coverage is through a job that offers health coverage.”
In addition to examining the adult population overall, Sommers and his colleagues also looked at how the ACA affected low-income residents in states that did and didn’t expanded Medicaid to those with incomes below 138% of the poverty level, or roughly $16,000 a year for an individual. They found that people in expansion states fared better.
For example, the study says, the percentage of low-income adults surveyed in expansion states who reported not having a personal physician dropped from 38.5% to 35.8%, while it remained at 43% in non-expansion states. And the percentage reporting “no easy access to medicine” dropped from 17.3% to 15% in expansion states and from 18.8% to 18.7% in non-expansion states among this population.
“As states continue to debate whether to expand Medicaid under the ACA,” the authors write, “these results add to the growing body of research indicating that such expansions are associated with significant benefits for low-income populations.”
But Roy disagrees, saying Medicaid “has mixed to poor outcomes in terms of expanding access to health care.”
“A lot of doctors don’t take Medicaid. A lot of people on Medicaid end up in the emergency room just like before the ACA,” he says. “The best way to expand access to health care is to make sure everybody can find work.”
