Healthcare insurance status and hypertension control before and after the Affordable Care Act

Blood pressure control among adults <65 years old with public, private, or no healthcare insurance after the US 2010 Affordable Care Act (ACA) is unknown.

National Health and Nutrition Examination Surveys were analyzed pre- (2001-2010) and post-ACA (2015-2023) on adults aged 20-64 years (pre-Medicare eligibility) with hypertension (systolic ≥140 or diastolic blood pressure ≥90 mmHg, or antihypertensive therapy). Relationships of blood pressure control (<140/<90 mmHg) to healthcare insurance and social determinants (race/ethnicity, low income [<200% federal poverty]) were assessed.

Among adults 20-64 years with hypertension pre- vs post-ACA, the uninsured (17.2% vs 11.4%) and the privately insured declined (64.3% vs 56.0%), while the publicly insured increased (16.2% vs 28.5%). Non-Hispanic Black and Hispanic adults comprised lower percentages of privately than publicly or uninsured adults, respectively, pre-ACA (18.9% vs 37.3%, 42.4%) and post-ACA (24.1% vs 38.3%, 50.3%). Low incomes were less frequent for privately insured adults than for publicly insured or uninsured adults, respectively, pre-ACA (13.0% vs 64.4%, 64.9%) and post-ACA (11.3% vs 67.6%, 63.1%). Blood pressure control was not different pre-ACA for publicly and privately insured adults (54.3% vs 50.4%, P = .064) and lower among uninsured adults (30.5%) than both insured groups, with a similar pattern post-ACA (54.5% [public], 50.2% [private], 30.3% [uninsured]).

In this US population-based study, blood pressure control was not different for publicly and privately insured adults pre- and post-ACA, although lower for uninsured adults. Public healthcare insurance appeared to continue mitigating the effects of adverse social determinants on blood pressure control post-ACA, despite the increase in publicly insured adults.