Related Experiment Video
Updated: Jul 15, 2026
Digital Home-Monitoring of Patients after Kidney Transplantation: The MACCS Platform
Published on: April 12, 2021
Coverage and Access for Americans With Chronic Disease Under the Affordable Care Act: A Quasi-Experimental Study
Hugo Torres1, Elisabeth Poorman1, Uma Tadepalli1
1From Harvard Medical School, Boston, Massachusetts.
Background:
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.
Objective:
To determine whether the ACA has had an effect on insurance coverage, access to care, and racial/ethnic disparities among adults with chronic disease.
Design:
Quasi-experimental policy intervention.
Setting:
Nationally representative, noninstitutionalized sample in the United States.
Patients:
606 277 adults aged 18 to 64 years with a chronic disease.
Intervention:
Implementation of ACA provisions on 1 January 2014.
Measurements:
Self-reported insurance coverage, having a checkup, having a personal physician, and not having to forgo a needed physician visit because of cost.
Results:
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.
Limitation:
The study examined data from only the first year of the ACA's major coverage expansion provisions.
Conclusion:
Although the ACA increased coverage and access for persons with chronic disease, substantial gaps remain, particularly for minorities and those in Medicaid nonexpansion states.
Primary Funding Source:
None.
Related Concept Videos
01:26Methods Of Healthcare Delivery System
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is limited...
01:16Crossover Experiments
Crossover designs are performed even with smaller sample sizes since the samples can act as their controls. These are better than simple randomized trials since patients are exposed to all the treatments.
01:15Methods of Documentation VI: Case Management Model
For example, a patient with a chronic illness...
01:22Standards of Care I
01:27Chronic Obstructive Pulmonary Disease-IV: Assessement and Diagnostic Studies
Medical History
01:23Types of Biopharmaceutical Studies: Controlled and Non-Controlled Approaches
Non-controlled studies, commonly employed for initial exploration, lack a control group, rendering them susceptible to biases and external influences. In contrast, controlled...