Uninsured patients who gained access to insurance through the Affordable Care Act (ACA) experienced improved health, better access to care, and reduced out-of-pocket costs, according to an analysis published online May 17 in Health Affairs.
The study provides a first glimpse of the longer-term effects of the ACA. The ACA is credited with extending insurance coverage to as many as 20 million individuals, about half of them through expanded Medicaid eligibility. However, the fate of the law and many of its provisions remains uncertain. A partial repeal of the ACA passed the US House of Representatives in May and is now in the hands of the US Senate.
Previous analyses based on the first 2 years of ACA implementation suggested that populations that benefited from Medicaid expansion had increased access to primary care, higher rates of some forms of preventive care, and higher self-reported health status. Their authors suggested longer-term data might show additional health benefits.
Now, Benjamin D. Sommers, MD, PhD, associate professor of health policy and economics at Harvard T.H. Chan School of Public Health, Boston, Massachusetts, and colleagues have analyzed 3 years of post ACA-implementation data on health status and healthcare use in three states. The investigators chose states with similar rates of uninsured before the first year of ACA implementation in 2013. The states were Kentucky, which expanded Medicaid eligibility through ACA; Arkansas, which helped low-income adults purchase private insurance on the healthcare marketplace; and Texas, which did not increase coverage for low-income adults.
The uninsurance rate dropped 20 percentage points in Kentucky and Arkansas compared with Texas. Those low-income individuals who gained coverage reported a 41 percentage point increase in having access to a usual source of health care and a 23 percentage point bump in the number of individuals reporting “excellent” health. On average, a newly covered adult saved $337 in out-of-pocket costs. Individuals also reported an increased likelihood of preventive glucose or cholesterol screening.
“Over three years of coverage expansion in two states, the ACA was associated with statistically significant and clinically relevant improvements for low-income adults’ access to care, use of preventive services, and self-reported health,” the authors write.
The authors also conducted a subgroup analysis on individuals with chronic conditions, including coronary artery disease, hypertension, stroke, asthma/chronic obstructive pulmonary disease, kidney disease, diabetes, depression, cancer, and substance abuse. These patients did not see a reduction in out-of-pocket costs; however, there was a 51 percentage point decrease in medication skipping, 56 percentage point increase in regular care for the chronic condition, and a 20 percentage point increase in individuals in this subgroup reporting excellent health.
“Among those with chronic conditions, coverage expansion was linked to improved medication adherence, more regular communication with physicians, and improved perceived health status,” the authors write.
Waits for specialty care did, however, increase in expansion states, particularly Kentucky. However, the authors suggest this may reflect the fact that many without coverage do not attempt to access specialty care, so did not experience wait times before having coverage.
The findings have important and timely implications as the nation once again debates a healthcare overhaul and some states consider whether to expand access to coverage through their state Medicaid program.
“As policy makers debate the ACA’s future and additional states consider whether to expand Medicaid, our findings demonstrate the benefits associated with coverage expansion for two particularly vulnerable populations: low-income adults and those with chronic conditions,” the authors conclude.
The authors have disclosed no relevant financial relationships.
Health Aff. Published online May 17, 2017. Full text
For more news, join us on Facebook and Twitter
Tidak ada komentar:
Posting Komentar