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Research Roundup: Studies Show Better Health Care Outcomes, Stronger Household Finances Thanks to Affordable Care Act & Medicaid Expansion

By May 21, 2018No Comments

Six new studies highlight the positive impact of the Affordable Care Act is having on health care in America. Three outcomes-focused studies show clear improvements in care for gynecological cancer, head and neck cancer, and serious psychological distress, while two Medicaid Expansion studies find that expanded coverage leads to lower out-of-pocket costs and stabler household finances. Meanwhile, health care reform has entirely closed the demographic coverage gap between Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPIs) and white Americans.

This new research joins a growing body of work that leads to a simple conclusion: the Affordable Care Act provides measurable benefits for Americans’ health and financial well-being. Here’s a look at the six studies:

Effects of the Affordable Care Act on Young Women With Gynecologic Cancers [Obstetrics & Gynecology, 5/7/18]

This study finds that the ACA’s expansion of access of coverage allowed more young women to catch gynecologic cancer early, improving the likelihood of successful treatment.

  • The study examined nearly 4,000 cases of gynecologic cancer among 21-26-year-old-women and more than 20,000 cases among 27-35-year-old women, comparing those which came about before the ACA and those after its implementation, finding that those with access were more likely to be treated.
  • The study found that prior to the ACA just one in three women between the ages of 19 and 26 were insured, but after its implementation, more than nearly four in five women were covered, helping to account for the diagnoses.
  • The report concluded that, “Young women with gynecologic cancer were more likely to be insured and diagnosed at an early stage of disease.”
  • “This study adds to the evidence of the positive effects of improved coverage through the ACA on young women’s healthcare costs and choices,” noted Dr. Laura Havrilesky, a gynecologist at the Duke University Medical Center, in an editorial published in accordance with the findings.

Changes in Health Insurance Coverage and Barriers to Health Care Access Among Individuals with Serious Psychological Distress Following the Affordable Care Act [Administration and Policy in Mental Health and Mental Health Services Research, 5/12/18]

This study examined mental health outcomes in accordance with the Affordable Care Act, concluding that the ACA has led to better coverage outcomes and increased affordability for non-elderly adults with serious psychological distress (SPD).

  • Examining non-elderly adults with SPD from 2014-2016, the study’s authors found that these adults saw increased coverage and a reduction in the delaying or foregoing of necessary care due to the ACA, and that the law “reduced the odds of an individual with SPD not being able to afford mental health care.”
  • As the study’s authors note, “Mental health care access among racial and ethnic minority populations and people with low income has improved during 2014–2016,” something almost certainly attributable, at least in part, to the ACA

ACA Decreased Non-Insurance Rates Among Patients With Head and Neck Cancer [American Head & Neck Society, 4/19/18]

Another new study finds that in states that expanded Medicaid, patients with head and neck cancer had better health care access.

  • The study analyzed more than 89,000 patients, finding higher coverage rates among both Medicaid enrollees and private insurance, as well as an uninsured rate among diagnoses which decreased nearly 50% after January 2014, in states which expanded Medicaid.
  • The study found that those lacking coverage had an overall survival rate of just 49% compared to 63% among those insured, as well as a a 5-year disease-specific survival rate of just 57% compared to 72% among those insured.

The Effect of the Affordable Care Act Medicaid Expansions on Financial Wellbeing [Journal of Public Economics, 5/7/18]

Another study compiled by employees of the Federal Reserve Bank of Chicago and the University of Illinois, University of Michigan, and Northwestern University found that low-income residents saw better financial outcomes in states which expanded Medicaid.

  • Using credit reporting agency data, the researchers compared the financial outcomes among low-income adults in states which expanded Medicaid and those which did not, determining that Medicaid expansion “significantly reduced d the number of unpaid bills and the amount of debt sent to third-party collection agencies among those residing in zip codes with the highest share of low-income, uninsured individuals.”
  • The study found that Medicaid expansion lowered unpaid balances in collections “by between $65 and $88,” while Medicaid enrollees saw their amount of unpaid balances in collections decrease “by approximately $1,140.”
  • As the authors note: “Our findings suggest that the ACA Medicaid expansions had important financial impacts beyond increasing health care use.”

The Effect of ACA State Medicaid Expansions on Medical Out-of-Pocket Expenditures [Medical Care Research and Review, 5/10/18]

A new analysis from the University of Michigan’s Institute for Social Research finds that Medicaid expansion lowered out-of-pocket medical expenses.

  • The study, conducted by Joelle Abramowitz of the Institute of Social Research, analyzed data from the Current Population Survey Annual Social and Economic Supplement between 2011-2016, finding that those in states which expanded Medicaid saw their medical spending decreases, due to fewer premiums and reduced out-of-pocket medical expenses.
  • The study’s findings “suggest that the expansions were associated with a relatively larger likelihood of having zero premium expenditures and of having zero nonpremium medical out-of-pocket expenditures for low-income individuals,” as well as suggest “that the expansions were effective in reducing medical out-of-pocket expenditures.”

Health Insurance for Asian Americans, Native Hawaiians, and Pacific Islanders Under the Affordable Care Act [JAMA Internal Medicine, 4/30/18]

Researchers from the Harvard T.H. Chan School of Public Health analyzed the impact of the Affordable Care Act on coverage among Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPIs), finding that the ACA closed the uninsured rate gap between AANHPIs and white Americans.

  • Using data from the American Community Survey, the researchers examined the uninsured rate among AANHPIs prior to the ACA and after its implementation, the first study of its kind, finding that unlike other minority groups which saw a decrease in the coverage gap between themselves and white Americans, the coverage gap among AANHPIS was eliminated.
  • Overall, the uninsured rate among AANHPIs dropped 7.3% following the ACA. Among the subgroups of AANHPIs, all saw significant drops: 14.3% among Guamanian or Chamorro, 6.5% among Samoan, and 4.9% among Native Hawaiians, as well as 5.9% among other AANHPIs.
  • “The notable gains in health insurance coverage for AANHPI groups represent valued progress toward health equity,” said senior author Howard Koh, the Harvey V. Fineberg Professor of the Practice of Public Health Leadership at Harvard Chan School and Harvard Kennedy School.