Assessing Individual Health Insurance Coverage and Utilization Before and After the Patient Protection and Affordable Care Act (original) (raw)
Related papers
Issue brief (Commonwealth Fund), 2015
This analysis compares access to affordable health care across U.S. states after the first year of the Affordable Care Act’s major coverage expansions. It finds that in 2014, uninsured rates for working-age adults declined in nearly every state compared with 2013. There was at least a three-percentage-point decline in 39 states. For children, uninsured rates declined by at least two percentage points in 16 states. The share of adults who said they went without care because of costs decreased by at least two points in 21 states, while the share of at-risk adults who had not had a recent checkup declined by that same amount in 11 states. Yet there was little progress in expanding access to dental care for adults, which is not a required insurance benefit under the ACA. Wide variation in insurance coverage and access to care persists, highlighting many opportunities for states to improve.
Rand health quarterly, 2011
The RAND Corporation's Comprehensive Assessment of Reform Efforts microsimulation model was used to analyze the effects of the Patient Protection and Affordable Care Act (PPACA) on employers and enrollees in employer-sponsored health insurance, with a focus on small businesses and businesses offering coverage through health insurance exchanges. Outcomes assessed include the proportion of nonelderly Americans with insurance coverage, the number of employers offering health insurance, premium prices, total employer spending, and total government spending relative to what would have been observed without the policy change. The microsimulation predicts that PPACA will increase insurance offer rates among small businesses from 53 to 77 percent for firms with ten or fewer workers, from 71 to 90 percent for firms with 11 to 25 workers, and from 90 percent to nearly 100 percent for firms with 26 to 100 workers. Simultaneously, the uninsurance rate in the United States would fall from 19...
BMC health services research, 2016
Health coverage in the United States will be increased to nearly universal levels under the Affordable Care Act (ACA). In order to better understand the impact of the type of health insurance and health outcomes, there is a need to examine health disparities and inequalities between the insured and the uninsured based on their eligibility for coverage. The current study used the data from the Medical Expenditure Panel Survey 2012 (MEPS). Selected health characteristics and access to care items were compared in regard to the insurance status: private, public, the uninsured, but likely eligible for Medicaid expansion (EME), and the uninsured, but likely required to purchase health plans through the health insurance exchanges (RPIE). Analyses showed that 17.2 % of US adults ages 27-64 were eligible as EME and 12.9 % as RPIE in 2012. Compared to the insured groups, the uninsured who were eligible for coverage reported fewer health problems than those insured privately and publicly. Howe...
A Long Way in a Short Time: States’ Progress on Health Care Coverage and Access, 2013-2015
2016
Issue: The Affordable Care Act's policy reforms sought to expand health insurance coverage and make health care more affordable. As the nation prepares for policy changes under a new administration, we assess recent gains and challenges. Goal: To compare access to affordable health care across the U.S. between 2013 and 2015. Methods: Analysis of most recent publicly available data from the U.S. Census Bureau and the Behavioral Risk Factor Surveillance System. Key findings and conclusions: Between 2013 and 2015, uninsured rates for adults ages 19 to 64 declined in all states and by at least 3 percentage points in 48 states and the District of Columbia. For children, uninsured rates declined by at least 2 percentage points in 28 states. The share of adults age 18 and older who reported forgoing a visit to the doctor when needed because of costs dropped by at least 2 percentage points in 38 states and D.C. In contrast, there was little progress in expanding access to dental care for adults, which is not a required benefit under the ACA. These findings illustrate the impact that policy can have on access to care and offer a focal point for assessing future policy changes. To learn more about new publications when they become available, visit the Fund' s website and register to receive email alerts.
The Sentinel Project: The ACA's Marketplace Reforms and Access to Care
Health Economics eJournal, 2014
The Patient Protection and Affordable Care Act (“ACA”) is intended to connect Americans with affordable, medically necessary health care. The first step toward achieving that goal is insurance expansion. The ACA’s first year of insurance expansion has allowed millions of Americans to newly obtain insurance. The second step recognizes that the content of health coverage matters, as appropriate insurance connects consumers with necessary care. The ACA therefore requires most plans offered in the individual and small group markets to cover a slate of ten essential health benefits (“EHBs”).There is a third necessary step in fulfilling the promise of the ACA. Once people are connected with insurance plans covering essential health benefits, it is vitally important that the plans deliver on the promise to provide necessary care in a timely, appropriate manner. The Sentinel Project of Seton Hall Law School will address this third step by assessing the market behavior of plans as consumers ...
JAMA, 2015
The Affordable Care Act (ACA) completed its second open enrollment period in February 2015. Assessing the law's effects has major policy implications. Objective: To estimate national changes in self-reported coverage, access to care, and health during the ACA's first two open enrollment periods, and to assess differences between lowincome adults in states that expanded Medicaid and in states that did not expand Medicaid. Design, Setting, and Participants: Analysis of the 2012-2015 Gallup-Healthways Well-Being Index, a daily national telephone survey. Using multivariable regression to adjust for pre-ACA trends and sociodemographics, we examined changes in outcomes for the nonelderly US adult population aged 18-64 (n= 507,055) since the first open enrollment period began in October 2013. Linear regressions were used to model each outcome as a function of a linear monthly time trend and quarterly indicators. We then compared pre-(January 2012-September 2013) and post-ACA (January 2014-March 2015) changes for adults with incomes below 138% of the poverty level in Medicaid expansion states (n = 48,905 in 28 states and Washington D.C.) versus non-expansion states (n=37,283 in 22 states) using differences-indifferences. Exposure: Beginning of the ACA's first open enrollment period (October 2013). Main Outcomes: Being uninsured, lacking a personal physician, lacking easy access to medicine, inability to afford needed care, self-reported health, and health-related activity limitations. Results: Among the 507,055 adults in this survey, pre-ACA trends were significantly worsening for all outcomes. Compared to the pre-ACA trend, the adjusted uninsured rate decreased 7.9 percentage points (95% CI-9.1,-6.7) by the first quarter of 2015; lacking a personal physician decreased 3.5 percentage points (95% CI-4.8,-2.2); lack of easy access to medicine decreased 2.4 percentage points (95% CI-3.3,-1.5); inability to afford care decreased 5.5 percentage points (95% CI-6.7,-4.2); the proportion reporting "fair" or "poor" health decreased 3.4 percentage points (95% CI-4.6,-2.2); and days with activities limited by health decreased 1.7 percentage points (95% CI-2.4,-0.9). Coverage changes were largest among minorities; for example, the decrease in the uninsured rate was larger among Latino adults (-11.9 percentage points; 95% CI-15.3%,-8.5%) than white adults (-6.1 percentage points; 95% CI-7.3,-4.8). Medicaid expansion was associated with significant reductions among low-income adults in the uninsured rate (differences-indifferences estimate,-5.2 percentage points; 95% CI-7.9,-2.6), lacking a personal physician, and difficulty accessing medicine. Conclusions: The ACA's first two open enrollment periods were associated with significantly improved trends in self-reported coverage, access to primary care and medications, affordability, and health. Low-income adults in states that expanded Medicaid reported significant gains in insurance coverage and access compared to adults in states that did not expand Medicaid.
Health Insurance Coverage Before and After the Affordable Care Act
Sci
The Affordable Care Act (ACA) is at the crossroads. It is important to evaluate the effectiveness of the ACA in order to make rational decisions about the ongoing healthcare reform, but existing research into its effect on health insurance status in the United States is insufficient and descriptive. Using data from the National Health Interview Surveys from 2009 to 2015, this study examines changes in health insurance status and its determinants before the ACA in 2009, during its partial implementation in 2010–2013, and after its full implementation in 2014 and 2015. The results of trend analysis indicate a significant increase in national health insurance rate from 82.2% in 2009 to 89.4% in 2015. Logistic regression analyses confirm the similar impact of age, gender, race, marital status, nativity, citizenship, education, and poverty on health insurance status before and after the ACA. Despite similar effects across years, controlling for other variables, youth aged 26 or below, th...
Health Equity
Purpose: To assess state-level variation in changes in uninsurance among Black, Hispanic, and low-income Americans after implementation of the Affordable Care Act (ACA). Methods: We analyzed data from the Behavioral Risk Factor Surveillance System from 2012 to 2016, excluding 2014. For Black, Hispanic, and low-income (< $35,000/year) adults 18-64 years of age, we estimated multivariable regression adjusted pre-(2012-2013) to post-ACA (2015-2016) percentage point changes in uninsurance for each U.S. state. We compared absolute and relative changes and the proportion remaining uninsured post-ACA across states. We also examined whether state-level variation in coverage gains was associated with changes in forgoing needed care due to cost. Results: The range in the percentage point reduction in uninsurance varied substantially across states: 19-fold for Black (0.9-17.4), 18-fold for Hispanic (1.2-21.5), and 23-fold for low-income (1.0-27.8) adults. State-level variation in changes in uninsurance relative to baseline uninsurance rates also varied substantially. In some states, more than one quarter of Black, one half of Hispanic, and approaching one half of low-income adults remained uninsured after full implementation of the ACA. Compared with states in the lowest quintile of change in coverage, states in the highest quintile experienced greater improvements in ability to see a physician. Conclusions: Performance on reducing uninsurance for Black, Hispanic, and low-income Americans under the ACA varied substantially among U.S. states with some making substantial progress and others making little. Post-ACA uninsurance rates remained high for these populations in many states.