The Affordable Care Act (ACA) was intended to improve access to health care for all Americans by expanding insurance coverage. The United States has the largest socioeconomic disparities in health care access of any wealthy country—but a new study, released by Health Affairs as a Web First, examines how the ACA has reduced that gap.
The authors, Kevin Griffith, Leigh Evans, and Jacob Bor, examined nationally representative survey data on US adults ages 18–64, collected by the Centers for Disease Control and Prevention, to determine the impact of the ACA on socioeconomic disparities. They found that in states that expanded eligibility for Medicaid, the gap in insurance coverage between people in poor households (incomes less than $25,000) and higher-income households (over $75,000) fell by 46 percent between 2013 and 2015. By contrast, in nonexpansion states, the coverage gap fell by only 23 percent. Income-related gaps in access to a primary care provider and avoiding care due to cost also declined more in expansion states than in nonexpansion states.
“Reducing [health access] disparities has been a subject of national debate since President Harry Truman proposed universal coverage in 1945,” the authors observed. “As we have shown in this analysis, the ACA substantially improved health insurance coverage and access to care for the poor and significantly reduced socioeconomic gaps in health care access in just two years…. More research is needed to determine whether existing access gains will translate into improved health outcomes and reductions in health disparities more broadly, and to monitor future trends in access disparities in a changing policy environment.”
The authors are affiliated with the Boston University School of Public Health. Griffith is also a researcher at the Veterans Affairs Boston Healthcare System.
This study will also appear in the August issue of Health Affairs.