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May 3, 2017

Study: ACA's coverage expansions did not disrupt access to care for previously insured

Daily Briefing

The Affordable Care Act's (ACA) health insurance expansions did not affect access to care for U.S. residents who already had insurance before the expansions took effect, according to a study published Monday in Health Affairs.

Study Details

For the study, researchers from the Agency for Healthcare Research and Quality (AHRQ) reviewed data from 2008 through 2014 on eight measures of access to care in AHRQ's Medical Expenditure Panel Survey. The data included responses from 41,512 U.S. adults.

The eight measures included both negative and positive indicators of access to care, such as whether an individual experienced delays in receiving necessary medical care and whether they had a routine checkup by a physician or other health professional in the prior year.


The researchers found no consistent evidence that increased health insurance coverage under the ACA hampered access to care for U.S. residents who were insured before the law's coverage expansions took effect and who stay insured after the expansions took effect. The findings account for individuals enrolled in Medicaid and those living in areas facing health care provider shortages.

However, the researchers did find that the ACA's coverage expansions had some positive effects on access to care. For example, the researchers found that a 1-percentage-point increase in local-area public insurance coverage rates was associated with a 1.63 percentage-point decrease in the likelihood individuals would have difficulty accessing a specialist. The researchers also found that the coverage expansions had positive effects on individuals having a usual source of care, as well as on the time it took for individuals to schedule doctor appointments.


The researchers said U.S. residents' access to care might have changed after 2014. However, they concluded  that the study's findings might be useful for states considering expanding Medicaid or using their own resources to increase enrollment in private health plans or health savings accounts (McIntire, Morning Consult, 5/1; Nather,"Vitals," Axios, 5/2;  Abdus/Hill, Health Affairs, May 2017; Larner, Health Affairs Blog, 5/1).

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