affordablecareactA three-state survey of the health of low-income people suggests that the Affordable Care Act (ACA) is the key to improved health. The study, published as an article online on August 8 in Internal Medicine (Journal of American Medical Association), was led by researchers at Harvard’s T. H. Chan School of Public Health. They set out “to assess changes in access to care, utilization, and self-reported health among low-income adults in 3 states (Kentucky, Arkansas, and Texas) taking alternative approaches to the ACA.”

Texas authorities have refused to implement the Medicaid expansion made possible by the Affordable Care Act, while Kentucky and Arkansas authorities made use of the ACA to expand services in different ways. The study’s researchers surveyed large numbers of low-income citizens in each state over the course of three years.

Their findings? Better levels of health and access prevail among low-income Arkansans and Kentuckians, who were about 5 percent more likely to say that they were in excellent health than were those in Texas. In addition, the number of the non-Texans reporting good health was growing over time, and their self-assessments proved to be highly accurate. This was true even though many people in Kentucky and Arkansas had yet to sign up for health insurance (by 2015, there had been just a 22.7 % reduction in the uninsured rate). The state groups studied were identical in gender, income, and marital status; the Texans skewed toward being younger and more urban. In the second year of ACA expansion, Kentucky and Arkansas people experienced “significant increases in outpatient utilization, preventive care, and improved health care quality; reductions in emergency department use; and improved self-reported health.”

Those in Kentucky and Arkansas were more likely to get access to healthcare and medications; those in Texas had higher levels of postponement of healthcare appointments and of inability to afford prescribed medications. Expansion made possible 12% more access to primary care. In the integrated model of healthcare, primary care physicians are expected to screen for behavioral health and make referrals to clinical social workers and other behavioral healthcare clinicians.

The Affordable Care Act was passed by Congress as a way of improving the health of 20 million people who had no healthcare coverage. Twenty state governments in the U. S. continue to deny their citizens the health advantages that were intended as the rights of all Americans. Louisiana just became the 31st state to implement the ACA Medicaid expansion.

Piece by Robert Booth.

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