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Affordable Care Act improved insurance coverage, access to health care for adults

Study shows greater improvement in health care coverage and access, especially for adults with chronic conditions living in states with higher pre-ACA uninsured rates

Since the implementation of the major components of the Affordable Care Act (ACA) in 2014, the effects of the ACA Medicaid expansion on health insurance coverage and access have been researched at length. The ACA’s influence on self-assessed health outcomes, on the other hand, has been less well studied. In addition, the coverage expansion’s effects on patients with chronic health conditions, representing over half of all adult Americans, has been relatively understudied.

A new study published by the Southern Economic Journal addresses these gaps in the literature. The research team included Benjamin Ukert, PhD, assistant professor in the Department of Health Policy & Management at the Texas A&M University School of Public Health, and colleagues from Georgia State University.

The study focused on analyzing the effects of the ACA Medicaid expansion on individuals with and without chronic health conditions. Data for analysis were obtained from the Behavioral Risk Factor Surveillance System (BRFSS), an annual survey about health and health behaviors conducted in all 50 states and Washington D.C. The researchers reviewed responses from adult Americans 19 to 64 years of age from households with income at or below the Federal Poverty Limit and collected before (2011-2013) and after (2014-2018) implementation of the ACA Medicaid expansion.

Participants were considered to have a chronic health condition if they reported being diagnosed with heart disease, cancer, chronic lung disease, stroke or diabetes. Data on insurance coverage, self-reported overall health status (poor, fair, good, very good or excellent), and other measures of self-reported health such as mental health and functional limitations were also included in the analyses.

The research team found that ACA Medicaid expansion resulted in large improvements in insurance coverage and access to health care for individuals with and without chronic health conditions, especially in states with high pre-ACA uninsurance rates. These effects began immediately following implementation in 2014 and grew throughout the post-expansion period. In contrast, only the group without chronic health conditions reported statistically significant levels of improvement in self-assessed overall health status. This difference in effect may reflect the need for relatively less care for this group to improve their health than would be necessary for the group with chronic illness.

The results of the study on improved coverage for and access to health care are similar to those of previous studies. However, the findings on the ACA Medicaid expansion’s impact on self-assessed health status and for patients with chronic health conditions are noteworthy for highlighting a less understood type of effect and an understudied group of patients.

– by Kelly Tucker

Media contact: Dee Dee Grays,, 979.436.0611

Tim Schnettler

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