In the 10 years since the Affordable Care Act (ACA) was signed into law, there have been several studies examining its impact. Aparna Soni, assistant professor in the AU School of Public Affairs (SPA), partnered with two other researchers to evaluate 43 of those studies to get a broader sense of how the federal law affected the health of Americans.

The resulting article, “How Have ACA Insurance Expansions Affected Health Outcomes? Findings From The Literature,” by Soni, Laura Wherry, assistant professor of medicine at the University of California-Los Angeles, and Kosali Simon, professor of public and environmental affairs at Indiana University, appears in the March issue of the journal Heath Affairs. The comprehensive review identified and summarized studies that used quasi-experimental research designs to assess the effects of ACA provisions on individuals’ health. This set of studies used particularly rigorous statistical methods to assess not just correlations, but solid causal links between the ACA and various health outcomes.

“We found overall encouraging evidence that the ACA improved health status, increased early detection of cancer and reduced mortality in targeted populations,” Soni said. “And the beneficial effects have grown as time went on.”

Although the ACA was passed in 2010, Soni noted that it wasn’t until 2014 that most of the major provisions were implemented, including the expansion of Medicaid to low-income adults and the creation of online health insurance exchanges where people can purchase regulated nongroup insurance policies. While most studies presented in the review article concluded that the ACA improved health status, a few found no impact of the ACA on people’s self-assessed health. This may be because most studies to date include only a few years of post-ACA data and it takes time for people to enroll, get coverage, go to the doctor and fully get the perks of insurance. Still, Soni said the results suggest overall improvements in people’s health and these improvements are only projected to magnify as people are covered for longer periods.

While efforts to repeal the ACA in its entirety have subsided, Soni said there is still vibrant debate around health policy. Today, 27 million Americans lack health insurance coverage, including many low-income residents living in states that did not expand Medicaid. In some states, work requirements have been added to Medicaid eligibility, which has translated to thousands of Americans in poverty losing insurance coverage.

“The evidence is clear that investments in public health and access to healthcare can lead to a healthier workforce and be good for the economy. Yet holes in the current system have created disparities in outcomes by race and between rural and urban Americans,” Soni said.
 
“I’m hoping that this study highlights the promising role that insurance expansions can play in improving people’s health and inform US health care reform going forward,” Soni said.