Should the ACA Be Abandoned? More Evidence Shows Things Aren’t So Bad

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Today’s AOA First Look features two stories on how the healthcare industry is putting pressure on the GOP to stabilize Affordable Care Act (ACA) Marketplaces.  A piece today from Axios shows that the big five for-profit U.S. health insurance companies  – Aetna, Anthem, Cigna, and UnitedHealth Group – cumulatively collected $4.5 billion in net earnings, which represents historically large profits in the first three months of 2017 and the biggest gains since ACA exchanges went live in 2014.  And, from the clinical care and public health perspective, a new Health Affairs article examining three-year impacts of the ACA shows that low-income adults demonstrated improvements in medical care and health as result of  ACA’s coverage expansion.

Because of policy uncertainty surrounding the ACA at state and federal levels, this study is important as it compares data assessing changes in health care use and self-reported health from low-income adults in three states: Kentucky, which expanded Medicaid; Arkansas, which expanded private insurance to low-income adults using the federal Marketplace; and Texas, which did not expand coverage. The analysis reveals several important findings related to health.  First, that the uninsurance rate in the two expansion states had dropped by more than 20 percentage points relative to the nonexpansion state. We know that having insurance is a major determinant to gaining access to and utilizing health care services. Second, for uninsured people gaining coverage, the authors found a “41% increase in having a usual source of care, a $337 reduction in annual out-of-pocket spending, significant increases in preventive health visits and glucose testing, and a 23% increase in ‘excellent’ self-reported health”. And lastly, that among adults with chronic conditions, the authors found “improvements in affordability of care, regular care for those conditions, medication adherence, and self-reported health”.

3 yrs ACA data

While this study is not the first (or only) evidence to demonstrate longitudinal impacts of the ACA, it certainly contributes to the overall discussion of the ACA’s value.  Of special significance is that this study compares population outcomes over time between expansion states versus a state where decision makers chose not to expand coverage for people at high risk and in need of health care coverage through Medicaid, a well-established model of providing coverage to low-income populations in the U.S.  And, with evidence to show insurer profits on the rise and mounting pressure from the health care industry to stabilize ACA marketplaces, those who advocate for fixing the ACA instead of replacing it have more evidence to strengthen their position.  This data also supports a primary objective of the ACA and shows it is being met – namely, that positive impacts from the ACA on population health are occuring over time.

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