ACA Improved Care and Health Among Low-Income Adults

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For uninsured people gaining coverage, this change was associated with a 41-percentage-point increase in having a usual source of care, a $337 reduction in annual out-of-pocket spending, significant increases in preventive health visits and glucose testing, and a 23-percentage-point increase in “excellent” self-reported health.

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Adults with chronic conditions—often called “preexisting conditions” in the current policy debate—saw numerous improvements in both access to and quality of care, including more checkups, improved adherence to medications, higher rates of regular care for chronic disease, and—perhaps as a consequence of these changes—improved self-reported health. These findings build on a previous study using national data through 2014 that showed gains in two access measures for adults with chronic conditions (having a checkup and no cost-related delays in care).39 However, our study included a much richer set of outcomes and two additional years of data.

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Over three years of coverage expansion in two states, the ACA was associated with statistically significant and clinically relevant improvements for low-income adults’ access to care, use of preventive services, and self-reported health. Among those with chronic conditions, coverage expansion was linked to improved medication adherence, more regular communication with physicians, and improved perceived health status. As policy makers debate the ACA’s future and additional states consider whether to expand Medicaid, our findings demonstrate the benefits associated with coverage expansion for two particularly vulnerable populations: low-income adults and those with chronic conditions.

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