Benjamin D. Sommers (
Bethany Maylone is a project manager at the Harvard T. H. Chan School of Public Health.
Health Aff (Millwood). 2017 Jun 1;36(6):1119-1128. doi: 10.1377/hlthaff.2017.0293. Epub 2017 May 17.
Major policy uncertainty continues to surround the Affordable Care Act (ACA) at both the state and federal levels. We assessed changes in health care use and self-reported health after three years of the ACA's coverage expansion, using survey data collected from low-income adults through the end of 2016 in three states: Kentucky, which expanded Medicaid; Arkansas, which expanded private insurance to low-income adults using the federal Marketplace; and Texas, which did not expand coverage. We used a difference-in-differences model with a control group and an instrumental variables model to provide individual-level estimates of the effects of gaining insurance. By the end of 2016 the uninsurance rate in the two expansion states had dropped by more than 20 percentage points relative to the nonexpansion state. For uninsured people gaining coverage, this change was associated with a 41-percentage-point increase in having a usual source of care, a $337 reduction in annual out-of-pocket spending, significant increases in preventive health visits and glucose testing, and a 23-percentage-point increase in "excellent" self-reported health. Among adults with chronic conditions, we found improvements in affordability of care, regular care for those conditions, medication adherence, and self-reported health.
主要政策不确定性继续围绕着平价医疗法案（ACA）在州和联邦层面。我们评估了 ACA 覆盖范围扩大三年后医疗保健使用和自我报告的健康状况的变化，使用从肯塔基州、阿肯色州和德克萨斯州三个州的低收入成年人收集的调查数据，这些州在 2016 年底结束：肯塔基州扩大了医疗补助；阿肯色州通过联邦市场向低收入成年人扩大了私人保险；德克萨斯州没有扩大覆盖范围。我们使用了具有对照组的差异差异模型和工具变量模型，以提供获得保险的个体水平估计。到 2016 年底，两个扩张州的无保险率相对于非扩张州下降了 20 多个百分点。对于获得保险的未保险者来说，这种变化与有常规医疗来源的人数增加了 41 个百分点，年自付支出减少了 337 美元，预防保健访问和葡萄糖检测显著增加，以及“优秀”自我报告的健康状况增加了 23 个百分点。在患有慢性疾病的成年人中，我们发现护理的负担能力、对这些疾病的定期护理、药物依从性和自我报告的健康状况有所改善。
