Study: Affordability remains a major problem despite insurance coverage gains from ACA

Photo of doctor and patient hands while discussing medical records after health examination
A new study found that affordability is still an issue for patients though that ACA expanded coverage. (andrei_r/GettyImages)

The number of people unable to see a physician due to cost has gone up in recent years despite coverage gains from the Affordable Care Act, a new study found.

The study published Monday in the Journal of the American Medical Association looked at changes in unmet needs for physician services ranging from 1998 to 2017 among insured and uninsured adults.

Researchers looked at a survey from the Centers for Disease Control and Prevention on behavioral risk factors from 1998 to 2017. During this period, the uninsured rate declined by 2.1 percentage points from 16.9% to 14.8%.

However, the proportion of people unable to see a physician due to cost increased by 2.7 percentage points, from 11.4% to 15.7%.

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“The adjusted proportion of persons with chronic medical conditions who were unable to see a physician because of cost also increased for most conditions,” the study said.

For instance, the number of patients with heart disease that couldn’t afford to see a doctor increased by 5.9% and cholesterol patients by 3.5%. Meanwhile, the proportion of chronically ill adults getting checkups did not change despite the increase in coverage.

The number of people getting cholesterol tests and flu shots increased but the proportion of women getting mammograms also decreased over the same time period.

The ACA increased coverage primarily by offering subsidies on individual market exchanges and by expanding Medicaid. So far there are 14 states that have not expanded Medicaid under the ACA.

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But affordability issues remain a key concern, as premiums for ACA exchange plans increased in 2017 and 2018, before declines in 2019 and 2020. A recent study found that premiums for the cheapest silver tier plan fell across 31 states for 2020.

In addition, the unsubsidized population on the exchanges dropped by 40% on the ACA exchanges from 2016 to 2018. However, enrollment in the population that gets subsidies to lower the cost of insurance has remained steady.