In the Journals

Medicaid expansions improved preventive care, but study finds Americans want changes to ACA

Due to insurance expansions of the Affordable Care Act, Americans were more likely to undertake preventive care, according to data published in Journal of Policy Analysis and Management. However, a recently released survey from NORC at the University of Chicago revealed that although essential components of the health care law are effective and popular, many Americans strongly support changes, but not an immediate repeal.

“The U.S. population receives suboptimal levels of preventive care and has a high prevalence of risky health behaviors,” Kosali Simon, PhD, of Indiana University’s School of Public and Environmental Affairs, and colleagues wrote. “One goal of the Affordable Care Act (ACA) was to increase preventive care and improve health behaviors by expanding access to health insurance.”

Simon and colleagues assessed how the ACA facilitated expansions of Medicaid impacted health behaviors using data from the CDC’s Behavioral Risk Factor Surveillance System and a difference-in-differences model that compared 30 states and the District of Columbia that either did or did not expand Medicaid benefits in 2014. They evaluated outcomes including preventive care, such as dental visits, immunizations, mammograms and cancer screenings; risky health behaviors, such as smoking, heavy drinking, lack of exercise and obesity; and self-assessed health.

The researchers found that due to the Medicaid expansions, low-income adults without children were 17% more likely to have health insurance; were 7% more likely to have a primary care physician; and were 11% less likely to indicate cost as a barrier to their health care. This population also showed improvements in self-assessed health and had fewer days of poor health or restricted activities. Overall, there was an increased use of preventive care, including flu vaccination, HIV testing and visiting a dentist.

“Our findings indicate that the Medicaid expansions under the ACA succeeded in some of their goals, but other goals remain hard to achieve,” Simon said in a related press release. “More people are seeing doctors and taking steps to safeguard their health. But there’s been no detectable reduction in obesity, smoking or heavy drinking, at least through our study period.”

However, there was no evidence that such risky behaviors increased.

While Simon and colleagues found the expansions of the ACA were effective in improving health behaviors of Americans, a nationwide poll of 1,036 adults conducted between Jan. 12-16, 2017 found 12% of participants want to keep the ACA in its current form and 40% support preserving the law but adding improvements. In addition, 16% support immediate repeal of the ACA, while 31% prefer not to repeal it until there is a complete replacement plan.

Although change is desired by most Americans, few reported that the ACA has negatively impacted them and almost half report not being affected at all, according to the survey. Furthermore, 27% reported that the ACA has improved their lives.

“It is clear that few Americans want to keep the law as it currently is,” Trevor Tompson, director of the Associated Press-NORC Center, said in the release. “However, there are many elements of the law that appear to be popular, and there is support for retaining those provisions in any replacement legislation that might be passed.” – by Alaina Tedesco

For more information:

www.apnorc.org/PDFs/Health%20Care%20Law/APNORC%20Americans%20Views%20on%20ACA%20Release.pdf

Disclosure: The researchers report no relevant financial disclosures.

Due to insurance expansions of the Affordable Care Act, Americans were more likely to undertake preventive care, according to data published in Journal of Policy Analysis and Management. However, a recently released survey from NORC at the University of Chicago revealed that although essential components of the health care law are effective and popular, many Americans strongly support changes, but not an immediate repeal.

“The U.S. population receives suboptimal levels of preventive care and has a high prevalence of risky health behaviors,” Kosali Simon, PhD, of Indiana University’s School of Public and Environmental Affairs, and colleagues wrote. “One goal of the Affordable Care Act (ACA) was to increase preventive care and improve health behaviors by expanding access to health insurance.”

Simon and colleagues assessed how the ACA facilitated expansions of Medicaid impacted health behaviors using data from the CDC’s Behavioral Risk Factor Surveillance System and a difference-in-differences model that compared 30 states and the District of Columbia that either did or did not expand Medicaid benefits in 2014. They evaluated outcomes including preventive care, such as dental visits, immunizations, mammograms and cancer screenings; risky health behaviors, such as smoking, heavy drinking, lack of exercise and obesity; and self-assessed health.

The researchers found that due to the Medicaid expansions, low-income adults without children were 17% more likely to have health insurance; were 7% more likely to have a primary care physician; and were 11% less likely to indicate cost as a barrier to their health care. This population also showed improvements in self-assessed health and had fewer days of poor health or restricted activities. Overall, there was an increased use of preventive care, including flu vaccination, HIV testing and visiting a dentist.

“Our findings indicate that the Medicaid expansions under the ACA succeeded in some of their goals, but other goals remain hard to achieve,” Simon said in a related press release. “More people are seeing doctors and taking steps to safeguard their health. But there’s been no detectable reduction in obesity, smoking or heavy drinking, at least through our study period.”

However, there was no evidence that such risky behaviors increased.

While Simon and colleagues found the expansions of the ACA were effective in improving health behaviors of Americans, a nationwide poll of 1,036 adults conducted between Jan. 12-16, 2017 found 12% of participants want to keep the ACA in its current form and 40% support preserving the law but adding improvements. In addition, 16% support immediate repeal of the ACA, while 31% prefer not to repeal it until there is a complete replacement plan.

Although change is desired by most Americans, few reported that the ACA has negatively impacted them and almost half report not being affected at all, according to the survey. Furthermore, 27% reported that the ACA has improved their lives.

“It is clear that few Americans want to keep the law as it currently is,” Trevor Tompson, director of the Associated Press-NORC Center, said in the release. “However, there are many elements of the law that appear to be popular, and there is support for retaining those provisions in any replacement legislation that might be passed.” – by Alaina Tedesco

For more information:

www.apnorc.org/PDFs/Health%20Care%20Law/APNORC%20Americans%20Views%20on%20ACA%20Release.pdf

Disclosure: The researchers report no relevant financial disclosures.