Assessing How Well the ACA Improved Access to Care and Affordability


An analysis revealed growing evidence of improved access to and affordability of care after the implementation of the Affordable Care Act, but gaps remain, especially for low-income adults.

The data show that the Affordable Care Act (ACA) has improved both access to care and affordability of care for nonelderly adults, according to a study published in Health Affairs.

An analysis of the Health Reform Monitoring Survey revealed growing evidence of improved access to and affordability of care, but gaps remain, especially for low-income adults. While there has been plenty if previous evidence showing the sharp decrease in the uninsured rate, little had been known about how gains in health insurance coverage impacted access and affordability.

“…the timeline for gains in access and affordability for the newly insured is difficult to predict, as these individuals may need to learn how to use their new insurance coverage and may need to change their care-seeking patterns and behaviors or may run into provider capacity issues as they seek care,” wrote authors Adele Shartzer, Sharon K. Long, and Nathaniel Anderson, all from the Health Policy Center at the Urban Institute when the study was conducted.

Between September 2013 and March 2015, access to care and affordability improved for adults at all income levels and regardless of whether or not their state expanded the Medicaid program. More low- and moderate-income adults reported having a usual source of care at the end of the study compared to the beginning of the study.

However, despite gains, more than one-fourth of adults reported they did not have a usual source of care. These adults were more likely to be between the ages of 18 years and 29 years, male, Hispanic, and have low income.

The authors reported that as consumers strengthened their connections to the healthcare system and increased their healthcare utilization, fewer adults reported problems obtaining care. These declines in access to care occurred across income and Medicaid expansion groups.

By the end of the study period, March 2015, slightly less than one-third (32%) of respondents reported they did not receive care because of the cost, which is a 2.7 percentage point decrease from September 2013. Unmet need for care because of cost did not change significantly among moderate and higher-income adults and decreases in both Medicaid expansion and nonexpansion states was not significant, but there was a marked decrease among low-income adults from 55.3% in September 2013 to 44.8% in March 2015.

“While we did see improvements in access and affordability early in the ACA implementation, we would expect additional gains over time as health insurance coverage becomes the norm for more Americans,” the authors wrote. “Continued monitoring of key outcomes is needed to assess whether those long-term gains are achieved.”

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