Coverage and Access for Americans With Chronic Disease Under the Affordable Care Act: A Quasi-Experimental Study

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Half of Americans have at least 1 chronic disease. Many in this group, particularly racial/ethnic minorities, lacked insurance coverage and access to care before the Patient Protection and Affordable Care Act (ACA) was enacted.


To determine whether the ACA has had an effect on insurance coverage, access to care, and racial/ethnic disparities among adults with chronic disease.


Quasi-experimental policy intervention.


Nationally representative, noninstitutionalized sample in the United States.


606 277 adults aged 18 to 64 years with a chronic disease.


Implementation of ACA provisions on 1 January 2014.


Self-reported insurance coverage, having a checkup, having a personal physician, and not having to forgo a needed physician visit because of cost.


After the ACA was implemented, insurance coverage increased by 4.9 percentage points (95% CI, 4.4 to 5.4), not having to forgo a physician visit increased by 2.4 percentage points (CI, 1.9 to 2.9), and having a checkup increased by 2.7 percentage points (CI, 2.2 to 3.4). Having a personal physician did not change (0.3 percentage points [CI, −0.2 to 0.8]). All outcomes varied considerably by state, and coverage increased more in states that expanded Medicaid. Although racial/ethnic minorities had greater improvements in some outcomes, approximately 1 in 5 black and 1 in 3 Hispanic persons with a chronic disease continued to lack coverage and access to care after ACA implementation.


The study examined data from only the first year of the ACA's major coverage expansion provisions.


Although the ACA increased coverage and access for persons with chronic disease, substantial gaps remain, particularly for minorities and those in Medicaid nonexpansion states.

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