Affordable Care Act Improved Access to Healthcare

Gains in healthcare access were made among lower-income Americans living in states that expanded Medicaid under the Affordable Care Act.

The implementation of the Affordable Care Act (ACA) resulted in millions more Americans gaining health coverage through ACA exchanges and Medicaid expansion.

Currently, President Donald Trump and GOP lawmakers have been seeking to repeal the health law in favor of legislation that would stabilize the insurance market and reduce costs.

The results from a new study published by Health Affairs suggest that the ACA has reduced the disparity in healthcare access between lower- and higher-income Americans.

Included in the study were survey data of adults aged 18 to 64 years. The data were collected by the CDC and assessed to determine the impact the ACA had on socioeconomic disparities related to insurance. Lower-income households were defined as an income of less than $25,000, while higher-income households were defined as an income of more than $75,000.

The authors discovered that the gap in insurance coverage between lower- and higher-income households dropped 46% between 2013 and 2015 in states with expanded Medicaid programs, according to the study.

In non-expansion states, this finding was less substantial. The gap between lower- and higher-income individuals was only reduced by 23%.

Gaps in access to primary care physicians and putting off care due to cost were also more significantly reduced in expansion states compared with non-expansion states, according to the study.

"Reducing health access disparities has been a subject of national debate since President Harry Truman proposed universal coverage in 1945," the authors wrote. "As we have shown in this analysis, the ACA substantially improved health insurance coverage and access to care for the poor and significantly reduced socioeconomic gaps in health care access in just 2 years."

Despite the improvement in access under the ACA, the authors reported that many individuals from lower-income households still went without coverage. In expansion states, 21% of lower-income individuals were uninsured, while 35% were uninsured in non-expansion states, according to the study.

Additionally, the authors discovered that many lower- and middle-income individuals did not seek healthcare due to costs in 2015.

"In its first 2 years of full implementation, the ACA improved health care access for Americans in low-income households, people who were not college graduates, and the unemployed," the authors wrote. "The law's Medicaid expansion was responsible for about half of these gains. The ACA was associated with a substantial (but incomplete) narrowing of socioeconomic disparities in access, particularly in states that expanded Medicaid."

The authors said that further studies are needed to determine if the observed gains will result in improved patient outcomes and additional reductions in disparities, while also monitoring future trends, according to the study.

"The US is an outlier among rich countries when it comes to our very large disparities in healthcare access between rich and poor," said senior author Jacob Bor, ScD. "The ACA, where it was fully implemented, cut these disparities in half, bringing the US much closer to our peers. Repealing the ACA, as proposed by President Trump and Republicans in Congress, would likely reverse these gains, exacerbating socioeconomic disparities in access."