Commonwealth Fund Issues Brief on the Effect of the Affordable Care Act on Health Care Access
One of the main goals of health reform like the Affordable Care Act (ACA) is to expand insurance coverage and, ultimately, to increase access to care. Among its reforms, the ACA expanded Medicaid coverage in participating states to all nonelderly adults with incomes below 133 percent of the federal poverty level (FPL), about $16,000 for an individual or $33,500 for a family of four, and provided subsidized insurance through the health care marketplaces for small businesses and individuals without access to employment-based insurance. Since the ACA’s first open enrollment period in the fall of 2013, the number of uninsured Americans has fallen from 41 million to 27 million.
Many prior studies have examined the relationship between insurance coverage and access to care. Virtually all have found that people with health insurance, whether Medicaid or private coverage, have better access to services. However, studies that compare people with and without coverage can be biased; people who choose to participate in coverage may differ from those who do not. For instance, people in poorer health may be more likely to sign up for care than healthy people. . .