While the Affordable Care Act (ACA) improved healthcare coverage for millions of Americans with chronic illnesses, many remained without coverage and faced barriers to getting regular medical care.
This is the conclusion of a study by researchers at Harvard Medical School titled “Coverage and Access for Americans With Chronic Disease Under the Affordable Care Act: A Quasi-Experimental Study,” published in the journal Annals of Internal Medicine.
The team studied data on 606,277 adults aged 18 to 64 with diseases such as asthma, chronic obstructive pulmonary disease (COPD), or a history of stroke, heart attack, cancer, chronic kidney disease, or arthritis in 2013, the year before ACA reforms were implemented, and in 2014, the first year after the ACA reforms.
“After the ACA was implemented, insurance coverage increased by 4.9 percentage points …, not having to forgo a physician visit increased by 2.4 percentage points …, and having a checkup increased by 2.7 percentage points,” researchers wrote in the study.
However, the team reported that the results varied considerably by state, and that the coverage increased more in states which implemented the ACA’s expansion of Medicaid coverage.
“Our finding that insurance coverage increased more in states that opted to expand Medicaid, and the fact that coverage rates were already lowest in non-expansion states before the ACA, highlights the importance of the Medicaid expansion for the chronically ill,” Hugo Torres, the study’s lead author and a physician at the Cambridge Health Alliance (CHA), said in a press release.
The team also found that racial and ethnic minorities exhibited greater improvements in some outcomes. However, “approximately 1 in 5 black and 1 in 3 Hispanic persons with a chronic disease continued to lack coverage and access to care after ACA implementation.”
“Patients with chronic diseases need to get regular medical care and take medications daily to prevent serious complications,” said Elisabeth Poorman, the study’s author and a primary care physician at CHA. “For the millions with a chronic disease that got coverage under the ACA, it is a big deal. But it is really unfortunate that so many chronically ill Americans remain uncovered despite the ACA.”
The study also found that, with the ACA, adults with chronic diseases were less likely to skip a doctor’s visit because of the cost, and were more likely to have had a check-up in the last year.
Although the study only looked at the year 2014, one year after the ACA’s major reforms were implemented, the authors consider it reasonable to expect there were also small improvements in 2015 and 2016.
The new administration and Republican leaders in Congress are on the verge of dismantling the ACA, although there are no official plans for its replacement.
“Repealing the ACA without an equivalent replacement would strip coverage from millions of chronically ill Americans, spelling disaster for many of them,” said Danny McCormick, the study’s senior author, a physician at CHA and an associate professor at Harvard Medical School. “A comprehensive Medicare-for-All plan is the replacement for the ACA that’s most likely to provide coverage and good access to care for everyone with a chronic illness.”
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