Sustained gains in coverage, access, and affordability under the ACA: A 2017 update

Health Affairs

Volumn 36, Issue 9, 2017, Pages 1656-1662

  Long, Sharon K ^a   Bart, Lea ^a   Karpman, Michael ^a   Shartzer, Adele ^a   Zuckerman, Stephen ^a  

^a URBAN INSTITUTE   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ADULT; FEMALE; FINANCIAL MANAGEMENT; HEALTH CARE SYSTEM; HUMAN; HUMAN EXPERIMENT; MALE; MEDICAID; MEDICALLY UNINSURED; MONITORING; POLITICS; SUMMER; ECONOMICS; HEALTH CARE DELIVERY; HEALTH CARE POLICY; HEALTH INSURANCE; HEALTH SURVEY; INSURANCE; MIDDLE AGED; STATISTICS AND NUMERICAL DATA; TRENDS; UNITED STATES;

ADULT; FEMALE; HEALTH SERVICES ACCESSIBILITY; HEALTH SURVEYS; HUMANS; INSURANCE COVERAGE; INSURANCE, HEALTH; MALE; MEDICAID; MEDICALLY UNINSURED; MIDDLE AGED; PATIENT PROTECTION AND AFFORDABLE CARE ACT; UNITED STATES;

EID: 85028812359     PISSN: 02782715     EISSN: 15445208     Source Type: Journal    
DOI: 10.1377/hlthaff.2017.0798     Document Type: Article

References (34)

1. Holahan J, Blumberg LJ. Instead of ACA repeal and replace, fix it [Internet]. Washington (DC): Urban Institute; 2017 Jan [cited 2017 Jul 26]. Available from: http://www.urban.org/research/publication/ instead-aca-repeal-and-replace-fix-it
2. Jost TS, Pollack H. Key proposals to strengthen the Affordable Care Act [Internet]. New York (NY): Century Foundation; 2015 Dec [cited 2017 Jul 26]. Available from: https://tcf.org/ content/report/key-proposals-tostrengthen-the-aca/
3. Courtemanche C, Marton J, Ukert B, Yelowitz A, Zapata D. Early impacts of the Affordable Care Act on health insurance coverage in Medicaid expansion and non-expansion states. J Policy Anal Manage. 2017;36(1): 178-210
4. Barnett JC, Vornovitsky MS. Health insurance coverage in the United States: 2015 [Internet]. Washington (DC): Census Bureau; 2016 Sep [cited 2017 Jul 26]. Available from: https://www.census.gov/content/ dam/Census/library/publications/ 2016/demo/p60-257.pdf
5. McMorrow S, Kenney GM, Long SK, Gates JA. Marketplaces helped drive coverage gains in 2015; affordability problems remained. Health Aff (Millwood). 2016;35(10):1810-5
6. Wherry LR, Miller S. Early coverage, access, utilization, and health effects associated with the Affordable Care Act Medicaid Expansions: a quasiexperimental study. Ann Intern Med. 2016;164(12):795-803
7. Cohen RA, Zammitti EP, Martinez ME. Health insurance coverage: early release of estimates from the National Health Interview Survey, 2016 [Internet]. Hyattsville (MD): National Center for Health Statistics; 2017 May [cited 2017 Jul 26]. Available from: https://www.cdc.gov/nchs/data/nhis/early release/insur201705.pdf
8. Sommers BD, Gunja MZ, Finegold K, Musco T. Changes in self-reported insurance coverage, access to care, and health under the Affordable Care Act. JAMA. 2015;314(4):366-74
9. Uberoi N, Finegold K, Gee E. Health insurance coverage and the Affordable Care Act, 2010-2016 [Internet]. Washington (DC): Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation; 2016 Mar [cited 2017 Jul 26]. Available from: https://aspe.hhs.gov/sites/default/ files/pdf/187551/ACA2010-2016.pdf
10. Auter Z. US uninsured rate rises to 11.7% [Internet]. Washington (DC): Gallup; 2017 [cited 2017 Jul 26]. Available from: http://www.gallup.com/poll/213665/uninsured-raterises. aspx
11. Shartzer A, Long SK, Anderson N. Access to care and affordability have improved following Affordable Care Act implementation; problems remain. Health Aff (Millwood). 2016; 35(1):161-8
12. There are several proposals, including those by the House, the Senate, and individual senators. For a summary, see Henry J. Kaiser Family Foundation. Compare proposals to replace the Affordable Care Act [Internet]. Menlo Park (CA): KFF; 2017 [cited 2017 Jul 26]. Available from: http://www.kff.org/interactive/ proposals-to-replace-the-affordablecare-act/
13. Holahan J, Blumberg LJ, Wengle E. Premium tax credits tied to age versus income and available premiums: differences by age, income, and geography [Internet]. Washington (DC): Urban Institute; 2017 May [cited 2017 Jul 26]. Available from: http://www.urban.org/research/ publication/premium-tax-creditstied-age-versus-income-andavailable-premiums-differencesage-income-and-geography
14. Congressional Budget Office. H.R. 1628, American Health Care Act of 2017 [Internet]. Washington (DC): CBO; 2017 May [cited 2017 Jul 26]. Available from: https://www.cbo.gov/publication/52752
15. Congressional Budget Office. H.R. 1628, Better Care Reconciliation Act of 2017 [Internet]. Washington (DC): CBO; 2017 Jun [cited 2017 Jul 26]. Available from: https://www.cbo.gov/publication/52849
16. Congressional Budget Office. H.R. 1628, Obamacare Repeal Reconciliation Act of 2017 [Internet]. Washington (DC): CBO; 2017 Jul [cited 2017 Jul 26]. Available from: https:// www.cbo.gov/publication/52939
17. For information on nonfederal surveys, see Karpman M, Long SK, Huntress M. Nonfederal surveys fill a gap in data on ACA [Internet]. Washington (DC): Urban Institute; 2015 Mar 13 [cited 2017 Jul 26]. Available from: http://www.urban.org/sites/default/files/publication/ 43741/2000146-Nonfederal-Surveys-Fill-a-Gap-in-Data-on-ACA.pdf
18. Finegold K, Gunja MZ. Survey data on health insurance coverage for 2013 and 2014 [Internet]. Washington (DC): Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation; 2014 Oct [cited 2017 Jul 26]. Available from: https://aspe.hhs.gov/system/files/pdf/77156/ ib_InsuranceEstimates.pdf
19. Census Bureau. American Community Survey: response rates [Internet]. Washington (DC): Census Bureau; [cited 2017 Jul 26]. Available from: https://www.census.gov/acs/ www/methodology/sample-sizeand-data-quality/response-rates/
20. National Center for Health Statistics. 2016 National Health Interview Survey (NHIS) public use data release: survey description [Internet]. Hyattsville (MD): NCHS; 2017 Jun [cited 2017 Aug 14]. Available from: ftp://ftp.cdc.gov/pub/Health_ Statistics/NCHS/Dataset_ Documentation/NHIS/2016/ srvydesc.pdf
21. Long SK, Kenney GM, Zuckerman S, Goin DE, Wissoker D, Blavin F, et al. The Health Reform Monitoring Survey: addressing data gaps to provide timely insights into the Affordable Care Act. Health Aff (Millwood). 2014;33(1):161-7
22. Karpman M, Long SK. QuickTake: HRMS benchmarks well against Gallup-Healthways and NHIS on changes in health insurance coverage between 2013 and 2015 [Internet]. Washington (DC): Urban Institute; 2015 Dec [cited 2017 Jul 26]. Available from: http://hrms.urban.org/quicktakes/HRMSBenchmarks-Well-against-Gallup-Healthways-and-NHIS-on-Changesin-Health-Insurance-Coveragebetween-2013-and-2015.html
23. To access the Appendix, click on the Appendix link in the box to the right of the article online
24. We focused on changes in insurance coverage because estimates of coverage levels often vary across survey programs as a result of survey differences unrelated to the ACA. See State Health Access Data Assistance Center. Comparing federal government surveys that count the uninsured [Internet]. Minneapolis (MN): SHADAC; 2013 Sep [cited 2017 Jul 26]. Available from: http://www.shadac.org/sites/default/files/ Old_files/shadac/publications/ ComparingFedSurveys_2013.pdf)
25. Medical care includes general doctor care, specialist care, medical tests, follow-up care, mental health care, and prescription drugs
26. For this analysis, Medicaid expansion states are those that expanded by March 2016: AK, AZ, AR, CA, CO, CT, DE, DC, HI, IL, IN, IA, KY, MD, MA, MI, MN, MT, NV, NH, NJ, NM, NY, ND, OH, OR, PA, RI, VT, WA, and WV. Because our definition of expansion states has changed as more states adopted the expansion, HRMS estimates based on Medicaid expansion status are not necessarily comparable over time
27. The regression models controlled for differences in the demographic, socioeconomic, and geographic characteristics of respondents and their families across the different rounds of the survey, as well as changes in the county employment rate. This removes changes in our outcomes caused by changes in types of respondents over time rather than by changes in the health care landscape
28. While the size of the estimated change in uninsurance and the time path of the decline vary across surveys, similar downward trajectories are reported in research based on both federal and nonfederal surveys. See Notes 3-10
29. While the percentage reduction was greater for adults ages 50-64 than for adults ages 35-49, there was not a significant difference in the change in the level of uninsurance between the two groups, which was roughly 6 percentage points
30. The drop in uninsurance among adults in expansion states was significantly larger than that for adults in nonexpansion states (p < 0.01)
31. Buettgens M, Kenney GM. What if more states expanded Medicaid in 2017? Changes in eligibility, enrollment, and the uninsured [Internet]. Washington (DC): Urban Institute; 2016 Jul [cited 2017 Jul 26]. Available from: http://www.urban.org/ research/publication/what-if-morestates-expanded-medicaid-2017-changes-eligibility-enrollment-anduninsured
32. Eibner C, Liu J, Nowak S. The effects of the American Health Care Act on health insurance coverage and federal spending in 2020 and 2026 [Internet]. Arlington (VA): RAND Corporation; 2017 [cited 2017 Jul 26]. Available from: https://www.rand.org/pubs/research_reports/ RR2003.html
33. Blumberg LJ, Buettgens M, Holahan J, Mermin GB, Sammartino F. Who gains and who loses under the American Health Care Act [Internet]. Washington (DC): Urban Institute; 2017 Mar 22 [cited 2017 Jul 26]. Available from: http://www.urban.org/research/publication/whogains-and-who-loses-underamerican-health-care-act
34. Blumberg LJ, Buettgens M, Holahan J, Mermin GB, Stallworth P. Who gains and who loses under the Better Care Reconciliation Act [Internet]. Washington (DC): Urban Institute; 2017 Jul 11 [cited 2017 Jul 26]. Available from: http://www.urban.org/research/publication/whogains-and-who-loses-under-bettercare-reconciliation-act