ACA increased primary care usage, but also some risky behaviors, report finds
- As more people gained healthcare coverage under the Affordable Care Act, preventive care increased but so did risky drinking, a new National Bureau of Economic Research report finds.
- The group looked at the ACA’s impact on behaviors affecting future health risks after the law had been in place for three years. Increases in checkups, pap tests and HIV tests were all statistically significant.
- However, the review also found an increase in some risky behaviors under the ACA. The likelihood that someone would become a risky drinker increased 1.6 percentage points. Smoking and exercise also showed signs of worsening, but not in a significant way.
Increasing preventive care was a major goal of the ACA, and these results show success in that direction. However, as the study suggests, preventive care doesn't necessarily lower costs in a significant way.
Increases were seen across a range of preventive care services. The number of checkups rose by 3.8 percentage points, flu shots by 1.9, pap tests by 4.3, mammograms by 1.5 and HIV tests by 2.1. The authors said their results imply that between 17% and 50% of newly insured people increased preventive care. That was an "economically meaningful" increase, according to the report.
Interestingly, all of the gains were due to expansion of private insurance under the law and not Medicaid expansion, NBER noted.
One reason for that may be that Medicaid payments, which lag behind private insurance rates, make it harder for enrollees to find a primary care provider or specialist, the authors suggest. It is also possible that expansion of private insurance through the ACA marketplaces strained the supply of doctors, edging out people on Medicaid.
As to why risky drinking increased, the authors note costs of alcohol, like food and gym memberships, are not directly influenced by health coverage. As a result, people may be less inclined to reduce their drinking until it affects their health.
The review has several limitations, including concerns about the accuracy of self-reported outcomes in the Behavioral Risk Factor Surveillance System, an annual telephone survey conducted by the Centers for Disease and Control.
“While our research offers important new information about the effects of the ACA over a longer time frame than most prior studies, our results nonetheless provide only one piece of a larger puzzle,” the report concludes. “Any comprehensive evaluation of the ACA would have to take into account effects on a wider range of other outcomes, including health, financial protection, health care expenditures, fiscal costs, employment, and wages.”
- National Bureau of Economic Research Effects of the Affordable Care Act on Health Behaviors after Three Years