title: Coverage and Access for Americans With Chronic Disease Under the Affordable Care Act: A Quasi-Experimental Study.
abstract: BACKGROUND
  Half of Americans have at least 1 chronic disease. Many in this group, particularly racial/ethnic minorities, lacked insurance coverage and access to care before the Patient Protection and Affordable Care Act (ACA) was enacted.
  
  
  OBJECTIVE
  To determine whether the ACA has had an effect on insurance coverage, access to care, and racial/ethnic disparities among adults with chronic disease.
  
  
  METHODS
  Quasi-experimental policy intervention.
  
  
  METHODS
  Nationally representative, noninstitutionalized sample in the United States.
  
  
  METHODS
  606 277 adults aged 18 to 64 years with a chronic disease.
  
  
  METHODS
  Implementation of ACA provisions on 1 January 2014.
  
  
  METHODS
  Self-reported insurance coverage, having a checkup, having a personal physician, and not having to forgo a needed physician visit because of cost.
  
  
  RESULTS
  After the ACA was implemented, insurance coverage increased by 4.9 percentage points (95% CI, 4.4 to 5.4), not having to forgo a physician visit increased by 2.4 percentage points (CI, 1.9 to 2.9), and having a checkup increased by 2.7 percentage points (CI, 2.2 to 3.4). Having a personal physician did not change (0.3 percentage points [CI, -0.2 to 0.8]). All outcomes varied considerably by state, and coverage increased more in states that expanded Medicaid. Although racial/ethnic minorities had greater improvements in some outcomes, approximately 1 in 5 black and 1 in 3 Hispanic persons with a chronic disease continued to lack coverage and access to care after ACA implementation.
  
  
  CONCLUSIONS
  The study examined data from only the first year of the ACA's major coverage expansion provisions.
  
  
  CONCLUSIONS
  Although the ACA increased coverage and access for persons with chronic disease, substantial gaps remain, particularly for minorities and those in Medicaid nonexpansion states.
  
  
  BACKGROUND
  None.
authors.affiliation: From Harvard Medical School, Boston, Massachusetts.
authors.forename: Hugo
authors.initials: H
authors.lastname: Torres
authors.affiliation: From Harvard Medical School, Boston, Massachusetts.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Poorman
authors.affiliation: From Harvard Medical School, Boston, Massachusetts.
authors.forename: Uma
authors.initials: U
authors.lastname: Tadepalli
authors.affiliation: From Harvard Medical School, Boston, Massachusetts.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Schoettler
authors.affiliation: From Harvard Medical School, Boston, Massachusetts.
authors.forename: Chin Ho
authors.initials: CH
authors.lastname: Fung
authors.affiliation: From Harvard Medical School, Boston, Massachusetts.
authors.forename: Nicole
authors.initials: N
authors.lastname: Mushero
authors.affiliation: From Harvard Medical School, Boston, Massachusetts.
authors.forename: Lauren
authors.initials: L
authors.lastname: Campbell
authors.affiliation: From Harvard Medical School, Boston, Massachusetts.
authors.forename: Gaurab
authors.initials: G
authors.lastname: Basu
authors.affiliation: From Harvard Medical School, Boston, Massachusetts.
authors.forename: Danny
authors.initials: D
authors.lastname: McCormick
mesh_terms: D000293:Adolescent; D000328:Adult; D002908:Chronic Disease / Q000208:ethnology* / Q000628:therapy*; D005260:Female; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D008297:Male; D008484:Medicaid / Q000331:legislation & jurisprudence; D008875:Middle Aged; D058991:Patient Protection and Affordable Care Act; D014481:United States; D055815:Young Adult