Soni Aparna, Wherry Laura R, Simon Kosali I
Aparna Soni is an assistant professor of public administration and policy in the School of Public Affairs, American University, in Washington, D.C.
Laura R. Wherry is an assistant professor of medicine in the David Geffen School of Medicine, University of California Los Angeles.
Health Aff (Millwood). 2020 Mar;39(3):371-378. doi: 10.1377/hlthaff.2019.01436.
A growing body of literature examining the effects of the Affordable Care Act (ACA) on nonelderly adults provides promising evidence of improvements in health outcomes through insurance expansions. Our review of forty-three studies that employed a quasi-experimental research design found encouraging evidence of improvements in health status, chronic disease, maternal and neonatal health, and mortality, with some findings corroborated by multiple studies. Some studies further suggested that the beneficial effects have grown over time and thus may continue to grow if the ACA insurance expansions remain in force. However, not all studies reported a significant positive relationship between ACA provisions that expanded insurance coverage and health status. We highlight the challenges facing researchers, including the importance of nonmedical factors in determining individual health and the use of outcome data predominantly drawn from self-reports. In closing, we identify opportunities to enhance researchers' understanding of the relationship between the ACA insurance expansions and health outcomes using new data sources, including electronic health records.
越来越多研究《平价医疗法案》（ACA）对非老年成年人影响的文献表明，通过扩大保险覆盖范围，健康状况有望得到改善。我们对43项采用准实验研究设计的研究进行回顾，发现了令人鼓舞的证据，表明健康状况、慢性病、孕产妇和新生儿健康以及死亡率都有所改善，一些研究结果得到了多项研究的证实。一些研究进一步表明，随着时间的推移，这些有益影响不断增强，因此，如果ACA的保险覆盖范围扩大政策继续实施，其影响可能会持续增强。然而，并非所有研究都报告称，扩大保险覆盖范围的ACA条款与健康状况之间存在显著的正相关关系。我们强调了研究人员面临的挑战，包括非医疗因素在决定个人健康方面的重要性，以及主要使用自我报告得出的结果数据。最后，我们指出了利用新数据源（包括电子健康记录）来增强研究人员对ACA保险覆盖范围扩大与健康结果之间关系理解的机会。
