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Impact Of The ACA On Health Outcomes

“The burgeoning body of research on the health effects of the ACA suggest promising improvements among nonelderly adults for certain health outcomes and some reductions in racial/ethnic disparities. Studies reported that the dependent coverage provision improved self-reported health, increased early-stage cancer diagnosis, reduced poor birth outcomes, and decreased opioid mortality for young adults.

“Findings for the Medicaid expansion were more varied. Results for self-reported physical and mental health were mixed, though the expansion increased early-stage cancer diagnosis, improved cardiovascular health, and reduced mortality for certain groups of nonelderly adults. In addition, there was some evidence that the health effects of the ACA grew over time, based on self-reported health measures.”

Source: Aparna Soni, Laura R. Wherry, and Kosali I. Simon. How Have ACA Insurance Expansions Affected Health Outcomes? Findings From The Literature. Health Affairs 2020 39:3, 371-378.

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Impact Of The ACA On Costs

“The direct effects of the ACA on Medicare payments, Medicaid spending on the newly eligible, and federal subsidies for Marketplace coverage can be reasonably well described and understood. The Congressional Budget Office estimated the direct effects of these changes on the federal budget repeatedly throughout the past decade in projecting the costs of ACA repeal, and it found that the on-budget costs of greater coverage were larger than the payment-related savings in Medicare—although not by much per year in the context of overall health spending. Similarly, there were other major changes in health spending that observers can agree were not triggered by the ACA or that were at most distally related. These changes include innovations in drug therapies, which have a development pipeline as long as or longer than our experience with the ACA to date; higher deductibles for consumers; and higher reimbursement rates for providers as the economy has recovered and providers have consolidated. Research indicates that provider consolidation predated the ACA’s value-based payment models.⁵⁵

“In the gray area between changes directly related to and unrelated to the ACA lie other reasons for slow growth in health care costs facilitated by the ACA. The most important of these factors may be spillovers from the value-based care initiatives described above and changes in investment decisions. Every day since the passage of the ACA, thousands of decisions have been made by health care providers with a greater awareness that their financial success will depend on delivering value. In our opinion, the increased attention paid to value-based payment by non-Medicare payers—namely, states and private insurers—is likely a key contributor to the slower rate of per capita cost growth that we’ve seen over the past decade.”

Source: Melinda Beeuwkes Buntin and John A. Graves. How The ACA Dented The Cost Curve. Health Affairs 2020 39:3, 403-412.

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Impact Of The ACA On Financial Barriers To Access To Healthcare

“Collectively, the ACA’s coverage expansions and market reforms generated substantial and widespread improvements in reducing financial barriers to coverage, improving access to health care, and lowering the financial risks of illness. The coverage expansions reduced uninsurance rates, especially relative to earlier forecasts; improved access to health care; and led to measurable gains in the financial well-being of poor Americans. The law’s market reforms reduced the burden of maintaining continuous eligibility for coverage and ensured that people with insurance had true risk protection.

“But subsequent court decisions, along with congressional and executive branch actions, have limited the ACA’s reach. The Supreme Court decision in NFIB v. Sebelius has left more than four million of the poorest Americans uninsured six years after the major coverage expansions.

“Congress and the administration of President Donald Trump have also chipped away at the law’s market reforms. Congress’s repeal of the individual mandate penalty, which took effect in 2019, is projected to increase the number of uninsured people by seven million over the next decade.⁴² The repeal of the mandate penalty dove-tailed with the Trump administration’s loosening of restrictions on insurance alternatives that are not required to comply with the ACA rules, such as short-term plans with risk rating and association health plans that do not cover all benefits.⁴³“

Source: Sherry A. Glied, Sara R. Collins, and Saunders Lin. Did The ACA Lower Americans’ Financial Barriers To Health Care?. Health Affairs 2020 39:3, 379-386.

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Impact Of The ACA On Women’s Health

“The ACA is responsible for some of the most significant advances for women’s health in recent decades through its increased access to health insurance and health care for women.^6,47 These advances affect the health not only of women but also of their families. After the ACA, women were more likely to be insured, to be able to afford health insurance and care, and to receive preventive care.^1,19,26 Expanded coverage of contraception improved its affordability and use.^40–42 The ACA’s Medicaid and insurance expansions were also associated with increased use of prenatal care⁶ and improved neonatal outcomes.⁵⁰ Nonetheless, health care disparities persist—especially among members of racial/ethnic minority groups and low-income women.^16,18

“To expand the ACA-related gains to all women, the ACA’s insurance coverage expansions must be strengthened. This includes expanding Medicaid in all states, maintaining the ACA Marketplace subsidies, and finding a legal way to institute an individual mandate.^1,51 The variability in state requirements for coverage of specific medications and mental health services should be reduced by ensuring broader coverage at the federal level. The standardization of essential health benefits should include coverage for comprehensive reproductive health care. The debate continues regarding employer exemptions from the ACA policy that requires contraception coverage without cost sharing.⁵² In 2018 the federal government proposed rules to expand exemptions for employers to include moral objections rather than just religious beliefs.⁵³ The rules are under a nationwide preliminary injunction, but conflicting federal court decisions are limiting the contraceptive policy’s enforceability.⁵²“

Source: Lois K. Lee, Alyna Chien, Amanda Stewart, Larissa Truschel, Jennifer Hoffmann, Elyse Portillo, Lydia E. Pace, Mark Clapp, and Alison A. Galbraith. Women’s Coverage, Utilization, Affordability, And Health After The ACA: A Review Of The Literature. Health Affairs 2020 39:3, 387-394

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Impact Of The ACA On Racial/Ethnic Disparities In Coverage And Access To Care

“The ACA produced broad gains in insurance coverage. A general pattern was that coverage increased most among groups whose members were most likely to be uninsured before the reforms. Initial research, based on the first few years after the ACA reforms took effect, found larger coverage gains for members of racial/ethnic minority groups than for whites.^1,8 Our analysis, which used data through 2017, found that this pattern had become even more pronounced by 2017, causing a further reduction in coverage disparities related to race/ethnicity. Other recent research has found that the ACA significantly reduced disparities in coverage related to other individual characteristics, such as income, age, marital status, and geographic location.^29,30

“ACA-related gains in insurance coverage coincided with improvements in standard measures of health care access. Here, too, compared to whites, we saw greater improvements for blacks and Hispanics—who before the ACA were substantially more likely to go without care for financial reasons and lack a usual source of care.”

Source: Thomas C. Buchmueller and Helen G. Levy. The ACA’s Impact On Racial And Ethnic Disparities In Health Insurance Coverage And Access To Care. Health Affairs 2020 39:3, 395-402.

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World Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems in the US and sixteen other nations.

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Page last updated June 4, 2023 by Doug McVay, Editor.