ACA update – a look at a few outcomes

Primary source : Amanda Toler Woodward, December 3, 2015

My Blogiversary came and went without any acknowledgment from me. What can I say – I’m not very good at planning parties, or even remembering anniversaries (sorry Husband). Plus, as we like to say, time flies and it’s hard to believe I’ve been doing this for a year.

It’s not entirely true that I forgot. I was at the Gerontological Society of America annual meeting and had every intention of live tweeting my experience there and writing a daily blog. I learned (or maybe relearned) that I don’t multitask very well which means live tweeting doesn’t work. I also relearned that by the end of a conference day all I’m capable of doing is curling up with room service and a novel. So no Blogiversary GSA bonanza.

I did, however, spend some time thinking about what I wanted to do for the year ahead. A few things came to mind. One is to continue to work on being more consistent in my posting. I’d also like to connect more with you, dear reader. Who are you? Why are you reading this? And what topics would be useful and interesting to you in the year ahead? Finally, I started this blog announcing that I wanted to write a book. That’s still in the works, but my blog posts have not always been bookish. Over the next year, I hope to blog the book a bit more. Having said that, tangents are fun and what’s the point of this if I can’t do what I want and have some fun?

Today’s post, however, is not all about me and my blogging challenges. It’s about the Affordable Care Act and some of the changes that are occurring now that two enrollment cycles have come and gone. Overall, almost 12 million people have signed up for marketplace coverage and another 12 million enrolled in Medicaid and the Children’s Health Insurance Program. The rates of people without health insurance has significantly declined since early 2014. A July article in JAMA looks at these results a bit more closely.

The study is based on data from a national sample of over 500,000 adults ages 18 to 64 and focuses on being uninsured, having a personal physician, the ability to get needed medication, difficulties affording needed medical care, overall health status, and the percentage of days in the past month when activities were limited by poor health.

Here are some of the authors’ key findings:

Before the ACA, all of these six outcomes were getting worse. The number of people without insurance or a personal physician, who had a harder time getting medication or medical care, and had declining health status, and the number of days when activities were limited by poor health were all increasing.

By the end of the second enrollment period, all of these outcomes had improved. And, with the exception of health status, this improvement was large enough to reverse the pre-ACA trends.

There were some differences in gains across subgroups:

  • Changes in insurance coverage and access to medications were greater among racial and ethnic minorities.
  • Access to medication improved more for urban residents than for those living in rural areas.
  • The affordability of care improved more for men than for women.

Medicaid expansion has been one of the contentious issues of the ACA. Expansion makes Medicaid eligible to adults under 65 with income up to 138% of the federal poverty level ($33,465 for a family of four) and for the first time provides Medicaid coverage for low-income adults without children. The ACA provides federal support to cover the costs of this expansion, but states can opt out. As I write this, 31 states have adopted the Medicaid expansion, 3 states are under discussion, and 17 have not adopted expansion.

In the JAMA article, low income people in states with Medicaid expansion are doing significantly better than those in states who have opted out of expansion.

There is a whole stew of financial, political, and ideological aspects to the expansion debate and the ACA in general that I will continue to ponder as I compare the U.S. and Finland’s approaches to elder care. If you’re a nerd like me, the Kaiser Family Foundation has lots of good ongoing analysis for your bedtime reading.

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Amanda Toler Woodward
Amanda Toler Woodward is an associate professor in the MSU School of Social Work. Her goal is to share reflections on a wide range of topics related to aging research, social work, academia, and whatever else catches her fancy.
Amanda Toler Woodward

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