title: Improvements in access and care through the Affordable Care Act.
abstract: OBJECTIVE
  To examine the impact of enrolling in a healthcare plan through the Affordable Care Act (ACA) healthcare exchanges on self-reported access to care.
  
  
  METHODS
  Cohort study using self-reported data of patients newly enrolled in Kaiser Permanente California and Kaiser Permanente Colorado through the ACA healthcare exchanges for coverage beginning January 1, 2014.
  
  
  METHODS
  Baseline and follow-up surveys conducted via mail and telephone, with response rates of 45% and 51%, respectively.
  
  
  RESULTS
  We found significant increases in the percentage of people who reported having a personal healthcare provider (59% vs 73%; P <.01) and significant decreases in those who reported delaying needed medical care due to costs (37% vs 25%; P <.01) before and after ACA enrollment. There was also a significant increase in the percentage of patients who reported receiving a flu shot during the prior year (41% vs 52%; P <.01). Among the people who reported having less than 4 months of healthcare coverage in 2013, these improvements were even more pronounced. This group also showed significant increases in the percentages who felt they had a place to go when they needed medical care (43% vs 56%; P <.01) and who reported they received advice to quit smoking or using tobacco (46% vs 72%; P <.05).
  
  
  CONCLUSIONS
  These findings are an important addition to the evidence base that the ACA is improving the healthcare experience and reducing barriers due to costs for individuals obtaining insurance coverage through the healthcare exchanges.
authors.affiliation: Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612. E-mail: Julie.A.Schmittdiel@kp.org.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Schmittdiel
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Barrow
authors.forename: Deanne
authors.initials: D
authors.lastname: Wiley
authors.forename: Lin
authors.initials: L
authors.lastname: Ma
authors.forename: Danny
authors.initials: D
authors.lastname: Sam
authors.forename: Christopher V
authors.initials: CV
authors.lastname: Chau
authors.forename: Susan M
authors.initials: SM
authors.lastname: Shetterly
mesh_terms: D000293:Adolescent; D000328:Adult; D002140:California; D003120:Colorado; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D058991:Patient Protection and Affordable Care Act; D058996:Quality Improvement; D014481:United States