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Member Research & Reports

Member Research & Reports

BU Finds Affordable Care Act Reduced Disparities in Health Care Access

The Affordable Care Act (ACA) has helped to close the gap in health care access between residents of poor and higher-income households, a new report by Boston University School of Public Health (BUSPH) researchers shows.

In an article in Health Affairs, the authors examined national survey data of US adults ages 18 – 64, collected by the Centers for Disease Control and Prevention, to determine the impact of the ACA on socioeconomic disparities in insurance coverage. They found that in states that expanded Medicaid, the gap in insurance coverage between residents of poor households (incomes of less than $25,000) and higher-income households (more than $75,000) fell by 46 percent between 2013 and 2015. By contrast, in non-expansion states, the coverage gap fell by only 23 percent.

The authors said that despite the substantial reductions in access gaps under the ACA, many residents with household incomes under $25,000 were still without coverage in 2015: 35 percent in non-Medicaid expansion states, and 21 percent in expansion states. In addition, in 2015, many low- and middle-income residents still reported avoiding care due to cost, the report said.

They said that more research is needed to determine whether existing access gains will translate into improved health outcomes and reductions in disparities, and to “monitor future trends in access disparities in a changing policy environment.”

“The U.S. is an outlier among rich countries when it comes to our very large disparities in health care access between rich and poor,” said senior author Dr. Jacob Bor, assistant professor of global health and epidemiology at BUSPH. “The ACA, where it was fully implemented, cut these disparities in half, bringing the U.S. much closer to our peers. Repealing the ACA, as proposed by President Trump and Republicans in Congress, would likely reverse these gains, exacerbating socioeconomic disparities in access.”

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