The Affordable Care Act expanded coverage for people with chronic illnesses, but its provisions fall short in ensuring those patients get the treatments and medications they need, according to a new study.
The number of people with chronic conditions that were insured increased by 5%, or about 4 million people, in 2014, the first year that most of the ACA reforms were in place, according to the research published in the Annals of Internal Medicine.
Yet even after implementation of the ACA, 15% of people with chronic diseases still lacked health insurance coverage and more than a quarter of them didn't get a checkup in 2014, according to the study. Furthermore, researchers found about 23% of people with chronic disease went without care because costs were still too high.
The gaps were greatest among blacks and Hispanics. The study found roughly 1 in 5 black people and 1 in 3 Hispanic people with a chronic disease continued to lack coverage and access to care after implementation of the ACA.
“The Affordable Care Act is not a universal coverage law. It’s a huge expansion for coverage but still left 20 to 30 million uninsured,” Benjamin Sommers, M.D., Ph.D., an associate professor of health policy and economics at Harvard T.H. Chan School of Public Health, who was not involved with the study, told Kaiser Health News. “Even for those with coverage, some are still experiencing challenges.”
The researchers examined records from the Behavioral Risk Factor Surveillance System for more than 600,000 people with at least one chronic disease and only through 2014. Sommers told KHN that it’s likely that the situation improved for those with chronic conditions in the years following the ACA’s full implementation, as more people understood how to get insurance and use it.
The researchers note that states that expanded Medicaid services had greater success ensuring more people were insured. Hospitals in states that expanded Medicaid saw compensated care costs drop by nearly $3 million each, in what was considered "a fiscal win" for those states.
Major elements of the ACA are on the chopping block as the Trump Administration and a Republican-controlled Congress gear up to roll back key tenets of the law through budget reconciliation. President Donald Trump issued an executive order on Inauguration Day last week urging a quick repeal, though concerns remain as to what exactly a GOP replacement would look like and when it would be in place. Trump advisers have suggested that Medicaid block grants and greater use of health savings accounts would be included, and the president himself has pushed for “insurance for everybody,” despite conflicts with the party line on that idea.