The Affordable Care Act (ACA) was passed in 2010, and nearly 100 studies have focused on measuring how effectively the law is achieving its intended goals. In a structured and systematic review, researchers from the University of Miami School of Business Administration and the Florida Atlantic University College of Business pooled the results of those studies to present an overview of the impact of the ACA on US health care.1
For their review, researchers searched major electronic databases for relevant studies published in peer-reviewed scholarly journals, as well as reports by government agencies and other organizations. Compiled data include overall health insurance coverage, access, and affordability; dependent coverage (adults younger than 26 years); use of marketplace subsidies; participation and competition in exchanges; and budgetary effects of the ACA.
The primary objectives of the ACA were to improve access to health insurance, reduce health care costs, and expand delivery of care. To that end, new health insurance plans were purchased through the marketplace by 11.7 million people, the number of people with Medicaid coverage increased by 10.8 million, and up to 3 million young adults remain on their parents’ policies thereby maintaining health insurance coverage up to their 26th birthday in the first 5 years since the ACA was signed.
Despite the strides made in the number of people with health insurance, some disparities remain:
The proportion of people without a regular source of health care decreased (29.8% in 2013 to 26% in 2014) yet almost 40% still have at least one concern regarding access to care.
Race, ethnicity, and income continue to be a factor in persistent disparities. For example, young, low-income Hispanics are more likely to be uninsured.
An estimated 2 to 4 million low-income to moderate-income persons cannot afford family coverage through their employers and do not qualify for financial assistance through the exchanges program.
The coverage gap in the nonexpansion states disproportionately affects blacks, who may earn too much to qualify for Medicaid but are also not eligible for tax credits in the marketplace.
The impact of premiums, deductibles, and other features of health insurance plans are the focus on some initiatives in process; however, The authors point out that the ACA has achieved two of its goals: reduce the number of uninsured and improve access to care.
However, expenditures (eg, premiums and deductibles for policy holders and mandates and taxes for employers and insurance carriers) are still increasing. Research initiatives currently underway are focusing on these issues.
“As new and comprehensive data become available, more rigorous evaluations will provide further insights as to whether the ACA has been successful in achieving its goals,” the authors conclude.
1. French MT, Homer J, Gumus G, Hickling L. Key provisions of the Patient Protection and Affordable Care Act (ACA): A systematic review and presentation of early research findings. Health Serv Res. 2016 Jun 5. doi: 10.1111/1475-6773.12511. [Epub ahead of print]