Two Years Later: Did Obamacare Really Expand Healthcare Access?

We are two years into the greatest national healthcare experiment in American history. The catalyst is a piece of legislation on which nearly everyone has an opinion: the Affordable Care Act (ACA), popularly known -- either affectionately or disdainfully -- as Obamacare.

Meant to expand access to health insurance nationwide, particularly for low-income Americans, proponents say it is succeeding. Though it is still too soon to declare the bill a success, data shows noticeable improvements in both healthcare access and perceived quality.

This is most clearly reflected in one of the key initiatives of the ACA, its expansion of Medicaid, an existing health insurance program meant to cover low-income Americans. But the bill, and a recent Supreme Court Decision, left the choice whether to expand Medicaid up to the states. While dozens of states took advantage of free federal money, several choose not to, mostly for partisan reasons.

ACA expanded access, but not for everyone

Dr. Benjamin Sommers, a physician and assistant professor of health policy and economics at Harvard University, worked with a team of researchers to examine healthcare access and self-reported health among low-income residents. They assessed two states that chose to expand Medicaid, Kentucky and Arkansas, and one that did not, Texas.

The team found marked differences in the states that increased access through Medicaid expansion.

“We saw these big gains in the first two years of the program in terms of people's ability to afford medical care, the likelihood that they have a primary care doctor, [and] their ability to find care in an office,” Sommers told TriplePundit. “In states ... that chose not to expand Medicaid under the ACA, most low-incomes adults still don't have a way of affording health insurance or getting most of the medical care they need.”

Sommers' findings mirror what others noticed in government data. States that expanded Medicaid, are, generally, seeing the number of people without health insurance going down, and quality of care going up. In states that did not choose to expand, there are some worrying trends.

That reflects a key challenge that is being faced across the country. The ACA broadly increased access to health insurance, but the ability to access affordable care in your own neighborhood isn’t a given for every American, particularly if you live in a state like Texas that is openly hostile to the ACA and limits the ability of residents to participate.

That is not to say that other initiatives aren't making a difference. One program that aims to bring simpler access to Americans are MinuteClinics, which were launched by CVS Health in 2000, and now count more than 1,100 locations in 33 states and the District of Columbia. MinuteClinics have provided care through more than 30 million patient visits, with a 95 percent customer satisfaction rating.

Moving the conversation forward

Initiatives such as MinuteClinics, or the countless nonprofit and charity initiatives operating at the local level across the country, can play a positive role -- particularly in states that chose not to expand Medicaid. But without proper government funding and outreach, this will only help in the margins. That is why Sommers sees a key role for these organizations as pushing for stronger action at the state level.

“This means taking the argument right to policymakers in states that haven't expanded Medicaid and making the case why this is needed, why this would help the health of the population," Sommers told us.

But what would make an even bigger difference is more sanity in our national discussion on healthcare policy. While the data shows numerous positive impacts from the ACA and Medicaid expansion, this is not to say the ACA is an unqualified success. It has strengths, but it also has flaws. And in an ideal world, we would come together to strengthen the bill so more Americans can access quality healthcare.

It won't be easy. Assessing the success of changes in health is difficult. This is partly due to the challenges in gathering data across large populations, but the main reason is human reality. It takes time for the results of massive policy changes like the ACA to reflect where it matters most – in regular people's lives.

“It's an unfolding story,” Sommers explained. “It's going to be another four, five, six years before the full story of the Medicaid expansion and the Affordable Care Act is told in the research."

As more information comes in, Sommers would like to see more data and fact-driven analyses driving policy in Washington, D.C., rather than the black-or-white arguments we see too often right now. That way, we can work to improve and build on the successes of the ACA, and also figure out how to make it work better for more Americans.

“Is it worth the cost? Are there better ways to deliver the care? Those are all very reasonable conversations to be had,” Sommers told us. “Unfortunately, right now with the environment of the ACA, things have been so polarized that there's been very little discussion about meaningful changes to the law.”

Still, we're moving in the right direction. As the ACA and Medicaid expansion become more ingrained in our national healthcare dialogue, and more data comes in showing their impacts, perhaps we can figure out what the next big step will be in ensuring that more Americans have access to quality, affordable and reliable healthcare.

Photo Credit: Michael Havens via Flickr