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ACA increased coverage, access for chronically ill patients, but barriers remain

The ability of the Affordable Care Act to provide adequate insurance coverage and access to health care for Americans with chronic medical conditions is concerning due to large remaining gaps, according to researchers in Annals of Internal Medicine.

“The prevalence of chronic disease in the United States rose steadily in the past decade, and half of adults now have at least one chronic medical condition,” Hugo Torres, MD, MPH, from Harvard Medical School, and colleagues wrote. “Access to health care is important to control chronic diseases and prevent complications. Yet millions of patients with chronic disease are uninsured, leading to major barriers to accessing needed medical care and contributing to high rates of ED and hospital use.”

Torres and colleagues assessed data from a nationally representative, noninstitutionalized sample of chronically ill patients aged 18 to 64 years (n = 606,277) 1 year before and after the implementation of the Affordable Care Act (ACA) to determine if the health care law expanded insurance coverage and access to care while reducing racial/ethnic disparities. The researchers evaluated self-reported data from patients on whether or not they had insurance coverage, obtained check-ups and saw a personal physician or needed to forgo a necessary physician visit due to cost.

Results indicated that within the first year of ACA implementation, 4.9% of patients with heart disease, cancer, asthma or other common chronic conditions gained insurance coverage. In addition, patients were less likely to forgo a physician visit because of cost and more likely to have a check-up in the last year, but there was no change in having a personal physician. State-by-state outcomes for each criterion varied considerably, but greater coverage was observed in states that expanded Medicaid (increasing from 83% before ACA to 89% after ACA).

However, approximately one in seven chronically ill patients still lacked coverage, according to the researchers. While racial/ethnic minorities showed improvements in some outcomes, there was still a lack in coverage and access to care after the implementation of ACA among nearly one in five black and one in three Hispanic patients with a chronic condition.

“Our findings suggest that the ACA's major coverage expansion starting in January 2014 resulted in meaningful improvements in coverage and access for Americans with chronic disease,” Torres and colleagues concluded. “However, these improvements seem modest relative to the proportion of adults who still lack insurance or face access barriers, problems that are widespread among racial and ethnic minorities and among persons residing in states that did not expand Medicaid. Although the ACA was not designed to achieve universal coverage, many lawmakers argued that it would come close. Our findings highlight the substantial hurdles that must be overcome in the future to optimize coverage and access and to eliminate disparities among those with chronic disease.” – by Alaina Tedesco

Disclosure: The authors report no relevant financial disclosures.