Has the Affordable Care Act Improved Patients’ Health?

Lead author, Benjamin D. Sommers, MD, PhD, comments about cumulative changes in study findings coathored by Atul Gawande, MD, and Katherine Baicker, PhD.

Peer Reviewed

Strong evidence suggests that expanding health insurance to more Americans increases access to care, improves health in a variety of ways, and reduces mortality, according to a recent literature review spanning more than a decade’s worth of evidence on the effects of insurance coverage on health.

family sheltered beneath an umbrella that says "Affordable Care Act".Strong evidence suggests that expanding health insurance to more Americans increases access to care.In the review, researchers examined evidence from more than 40 studies to determine what impact insurance coverage has on health and mortality, if any. The findings were published online ahead of print on June 21 in the New England Journal of Medicine.

The health benefits appear to reflect modest cumulative changes stemming from earlier detection of disease, improved medication adherence and management of chronic conditions, and “in psychological well-being born of knowing one can afford care when one gets sick,” the researchers wrote.

In contrast, policies that reduce health care coverage may “produce significant harms to health,” particularly among poorer patients and those with chronic health conditions, the researchers noted. 

“We know far more now about the effects of health insurance than we did when the Affordable Care Act (ACA) was originally passed, due to many recent high-quality studies,” said lead author Benjamin D. Sommers, MD, PhD, in a press release. “The evidence we reviewed in this paper shows that coverage makes a major difference in people’s ability to live healthier and longer lives,” said Dr. Sommers, Associate Professor of Health Policy and Economics at Harvard Chan School, Associate Professor of Medicine at Harvard Medical School.

Coauthors of the paper include Atul A. Gawande, MD, MPH, and Katherine Baicker, PhD. Dr. Gawande is the Samuel O. Thier Professor of Surgery at Harvard Medical School, a Professor in the Department of Health Policy and Management at the Harvard T.H. Chan School of Public Health, and a practicing surgeon at Brigham and Women’s Hospital.

Data Analysis
The researchers synthesized the most rigorous evidence from the past decade, drawing on findings from more than 40 papers, including major studies of their own. The body of evidence showed that coverage expansions have produced significantly higher rates of being able to afford needed care, and having access to preventive services, primary care, chronic illness treatment, medications, and surgical care. In turn, these changes have led to a wide range of improvements in health (Table).

Table. Health Improvements Resulting From Expanded Health Insurance Coverage in the United States

  • People who obtain health insurance coverage report significant improvement in their overall health, a generally consistent finding across studies of Medicaid expansion, private insurance expansion, Massachusetts health reform, and the ACA. The authors noted that research also shows that better self-reported health is associated with lower mortality rates.
  • Insurance has major benefits for people with depression—one of the most common chronic conditions in the U.S.—including improved rates of diagnosis and treatment and reduced symptoms.
  • Several large population-based studies of health insurance expansion find that it saves lives, with the largest reductions occurring among deaths from conditions that are frequently treatable with adequate medical care, such as infections, heart disease, and cancer.
  • Despite increasing overall health spending, coverage expansions are relatively cost-effective compared to other policies affecting mortality, according to a recent economic analysis.
    Source: Sommers et al.

The authors acknowledged that findings from many of the studies they reviewed are nuanced, and some are seemingly contradictory, partly because of differing study design or length as well as the complexity of the links between insurance coverage and particular health effects. People with health insurance are also more financially secure, with lower out-of-pocket spending and fewer medical debts. These gains must be weighed against the cost of financing public subsidies for insurance, the authors noted.

The authors concluded that many questions about U.S. health insurance policy remain unanswered “including how to best structure coverage to maximize health and value and how much public spending we want to devote to subsidizing coverage for people who cannot afford it. But whether enrollees benefit from that coverage is not one of the unanswered questions. Insurance coverage increases access to care and improves a wide range of health outcomes.”

Updated on: 03/20/18
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Benjamin D. Sommers, MD, PhD
Department of Health Policy and Management
Harvard T.H. Chan School of Public Health
Boston, MA
Atul Gawande, MD, MPH
Department of Health Policy and Management
Harvard T.H. Chan School of Public Health
Boston, MA
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