Coverage and Access for Americans With Chronic Disease Under the Affordable Care Act: A Quasi-Experimental Study
By Hugo Torres, MD, MPH; Elisabeth Poorman, MD, MPH; Uma Tadepalli, MD; Cynthia Schoettler, MD, MPH; Chin Ho Fung, MD; Nicole Mushero, MD, PhD; Lauren Campbell, MD, MPH; Gaurab Basu, MD, MPH; Danny McCormick, MD MPH
Annals of Internal Medicine, January 24, 2017
Background:
Half of Americans have at least 1 chronic disease. Many in this group, particularly racial/ethnic minorities, lacked insurance coverage and access to care before the Patient Protection and Affordable Care Act (ACA) was enacted.
Objective:
To determine whether the ACA has had an effect on insurance coverage, access to care, and racial/ethnic disparities among adults with chronic disease.
From the Results:
Despite improvements after ACA implementation, large proportions of adults with chronic disease continued to lack coverage or access. Overall, after the ACA took effect, 14.9% of persons with chronic disease nationally continued to lack insurance, 22.8% had to forgo a physician visit, 18.1% did not have a personal physician, and 27.6% did not have a checkup. In addition, we found the persistent lack of coverage and access after ACA implementation was particularly great among racial minorities, despite the greater gains as a result of the ACA. Approximately one fifth of blacks had persistent post-ACA gaps, ranging from 17.5% lacking coverage to 26.8% forgoing a physician visit. Approximately one third of Hispanics had persistence post-ACA gaps, ranging from 29.7% lacking coverage to 32.9% forgoing a physician visit.
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Comment:
By Don McCanne, M.D.
Many people have benefited by gaining access and coverage under the Affordable Care Act, but this study shows that far too many people with chronic disease have been left out, particularly amongst blacks and Hispanics.
We can do far better. An improved Medicare for all, with automatic enrollment of everyone, would close the gaps without spending any more than we do already. That would be vastly superior to any of the proposals that are currently being considered as a replacement for ACA.