Coverage and Access for Americans with Cardiovascular Disease or Risk Factors After the ACA: a Quasi-experimental...

Area of Science:

• Public Health
• Health Policy
• Cardiovascular Medicine

Background:

• Atherosclerotic cardiovascular disease (CVD) is a leading cause of death in the USA.
• Many individuals with CVD or cardiovascular risk factors (CVRFs) previously lacked insurance and access to care.
• The Affordable Care Act (ACA) aimed to address these disparities.

Purpose of the Study:

• To evaluate the ACA's impact on insurance coverage.
• To assess changes in healthcare access among non-elderly adults with CVD or CVRFs.
• To examine racial/ethnic disparities in coverage and access post-ACA.

Main Methods:

• Utilized a quasi-experimental policy intervention design.
• Analyzed a nationally representative sample of 1,014,450 non-institutionalized adults aged 18-64.
• Compared pre-ACA (2012-2013) and post-ACA (2015-2016) periods.

Main Results:

• Insurance coverage increased by 6.9 percentage points post-ACA.
• Access to care, including physician visits and check-ups, significantly improved.
• Improvements were more pronounced for lower-income individuals and in Medicaid expansion states.
• Racial/ethnic minorities experienced greater improvements but still faced coverage gaps.

Conclusions:

• The ACA demonstrably enhanced insurance coverage and healthcare access for adults with CVD or CVRFs.
• Persistent disparities in coverage and access remain, particularly for minority groups.
• Medicaid expansion status and state-level policies significantly influenced ACA's effectiveness.