The Affordable Care Act (ACA) improved access to healthcare for millions of Americans and reduced barriers to care, according to a new Commonwealth Fund report.
The ACA resulted in a record low of uninsured working-age adults and children. The law also led to “reductions in cost-related access problems and improvements in access to routine care for at-risk adults, particularly in states that expanded Medicaid.”
The report estimated the uninsured rate for adults between 19 and 64 declined in all states and the District of Columbia. The rate dropped by at least five percentage points in 47 states.
The Commonwealth Fund conducted the study “given uncertainty about the future of the Affordable Care Act.” The report looked into the progress made in terms of more health insurance coverage and access to healthcare since the ACA.
The report found that only four states and D.C. had fewer than 10% uninsured in 2013 and 10 states had more than 20% uninsured. By 2016, 27 states and D.C. had fewer than 10% uninsured and no states had more than 20% uninsured.
The Commonwealth Fund said the ACA also improved access to care by reducing financial burdens. Between 2013 and 2016, the percentage of adults who reported a time in the last year when they avoided care because of cost decreased from 16% to 13% nationwide. The largest results were in Arkansas, California, Kentucky, New Mexico, Oregon, Tennessee and Washington. All of those states except Tennessee expanded Medicaid, according to the report.
The Commonwealth Fund also found that insured rates improved for at-risk adults without a recent routine checkup and people who spent a high portion of income on medical care. “Medicaid expansion made a clear difference in reducing cost barriers to care for low-income and minority adults,” the study found.
The Commonwealth Fund said the ACA also removed barriers to healthcare access for children. Between 2013 and 2016, the uninsured rate for children dropped from 8% to 5%. Thirty-three states saw their uninsured rates for children drop by at least two percentage points. On the other hand, North Dakota saw its uninsured children rate increase by two percentage points between 2013 and 2016, and Alaska’s rate increased two points between 2015 and 2016. Only those two states and Texas have at least 10% of children uninsured.
While promoting the ACA's gains, the report warns that actions and inactions in Washington this year “could jeopardize the gains made to date.” The report specifically cites the Trump administration cutting the ACA plan open enrollment in half, Congress not yet extending funding for the Children’s Health Insurance Plans (CHIP) and the potential repeal of the individual mandate’s penalties, which is part of the current tax bill on Capitol Hill. These could all reverse the gains made since the ACA took effect, the authors warn.