Advocates for Evidence-Based Health Policy Speakers
Obama’s Life-Saving Legacy
The Affordable Care Act (ACA) is one of the most monumental health policy changes in the United States since the creation of Medicaid and Medicare in 1965. However, since its enactment, the ACA has proved to be a contentious piece of legislation with claims of its successes and failures decided along partisan lines. Researchers have attempted to objectively evaluate whether the ACA has been able to achieve its stated goals in regard to access to care, insurance coverage, and costs.
A recent study examined the effects Medicaid expansion had on health using self-reported health status 5 years after expansion. Using data from the Behavioral Risk Factor Surveillance System from 2011-2018, the authors created difference-in-differences models, accounting for demographic, population, and time-dependent effects between states. Results showed self-reported health status significantly improved for 25- to 54- year olds living below 100% of the federal poverty level (FPL) from in 2014 to 2018, with similar effects not seen for groups between 138% and 400% FPL.
The authors also noted that the first statistically significant improvement was in 2015 after implementation, reflecting improvements in Medicaid take-ups rates which take time to be observed. Models also depicted a significant improvement in health status ratings for the following subgroups: women, those with children at home, and all racial or ethnic groups other than non-Hispanic whites.
The authors concluded that although they found “limited support of evidence for the notion of increased health over the 5 post expansion years,” the results suggested that improvements in self-rated health were concentrated among those with unmet needs prior to Medicaid expansion. This final fact, however, is not one to be taken lightly. The evidence illustrates that low-income individuals in Medicaid expansion states have benefitted in ways that low-income individuals in non-expansion states have not. Researchers should continue to monitor the effects the ACA has had on population health with the understanding that both the subjective and the objective data will enable policymakers to truly begin to fully understand how much the ACA has improved American’s health.
This Health Policy Journal Club review is written by Ariana Olvera as part of our collaboration with the Health Policy Journal Club at Baylor College of Medicine where she is a medical student.
Abstract
We examine the Affordable Care Act Medicaid expansion effects on self-rated health status over 5 years. The study uses data from the Behavioral Risk Factor Surveillance System for 2011-2018 and a difference-in-differences design. There is improvement in health status on a 1 to 5 point scale from poor to excellent health among individuals below 100% of the federal poverty line by 0.031, 0.068, 0.031, 0.064, and 0.087 points in 2014, 2015, 2016, 2017, and 2018, respectively. Changes in 2015, 2017, and 2018 are statistically significant (p < .05), and the 2014 change is marginally significant. The difference between 2014 and 2018 effects is statistically significant (p < .05). In most years, we cannot distinguish changes in days not in good physical or mental health from no effect. Overall, there is only minimal evidence for effects intensifying over time, suggesting that health gains thus far have mostly occurred early on due to unmet needs among those previously uninsured.
PMID: 33218289
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