Three-Year Impacts Of The Affordable Care Act: Improved Medical Care And Health Among Low-Income Adults
Three-Year Impacts Of The Affordable Care Act: Improved Medical Care And Health Among Low-Income Adults
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DOI：
10.1377/hlthaff.2017.0293
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发表时间：
2017-06-01
期刊：
影响因子：
9.7
通讯作者：
Epstein, Arnold M.
中科院分区：
文献类型：
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作者：
Sommers, Benjamin D.;Maylone, Bethany;Epstein, Arnold M.
州和联邦层面的《平价医疗法案》(ACA) 仍然存在重大政策不确定性。我们使用截至 2016 年底从三个州低收入成年人收集的调查数据，评估了 ACA 覆盖范围扩大三年后医疗保健使用和自我报告健康状况的变化：肯塔基州，扩大了医疗补助；阿肯色州，利用联邦市场将私人保险扩大到低收入成年人；德克萨斯州没有扩大覆盖范围。我们使用带有对照组的双重差分模型和工具变量模型来提供获得保险效果的个人水平估计。到2016年底，两个扩张州的未保险率相对于非扩张州下降了20多个百分点。对于获得保险的未参保人群来说，这一变化与拥有常规护理来源的人数增加了 41 个百分点、年度自付费用减少了 337 美元、预防性健康就诊和血糖测试显着增加以及“优秀”自我报告健康状况增加了 23 个百分点有关。在患有慢性病的成年人中，我们发现护理负担能力、对这些疾病的定期护理、药物依从性和自我报告的健康状况有所改善。
Major policy uncertainty continues to surround the Affordable Care Act (ACA) at both the state and federal levels. We assessed changes in health care use and self-reported health after three years of the ACA's coverage expansion, using survey data collected from low-income adults through the end of 2016 in three states: Kentucky, which expanded Medicaid; Arkansas, which expanded private insurance to low-income adults using the federal Marketplace; and Texas, which did not expand coverage. We used a difference-in-differences model with a control group and an instrumental variables model to provide individual-level estimates of the effects of gaining insurance. By the end of 2016 the uninsurance rate in the two expansion states had dropped by more than 20 percentage points relative to the nonexpansion state. For uninsured people gaining coverage, this change was associated with a 41-percentage-point increase in having a usual source of care, a $ 337 reduction in annual out-of-pocket spending, significant increases in preventive health visits and glucose testing, and a 23-percentage-point increase in "excellent" self-reported health. Among adults with chronic conditions, we found improvements in affordability of care, regular care for those conditions, medication adherence, and self-reported health.