Agirdas
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Karatina University *
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412
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Health Science
Date
Nov 24, 2024
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docx
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2
Uploaded by BrigadierLightning12336
Affordable Care Act, ACA
Agirdas, C. (2021). How Did the Affordable Care Act Affect Risky Health Behaviors?
Applied Health Economics and Health Policy
. https://doi.org/10.1007/s40258-021-
00699-5
Background The Affordable Care Act (ACA) expanded insurance coverage in the USA through
Medicaid expansions, insur- ance marketplaces, subsidies, and mandates in 2014. Insurance coverage
at such a large scale may affect individuals’ risky health behaviors such as smoking, excessive
drinking, overeating, not exercising, and illicit substance use. Those effects are not easy to predict,
and they may be positive or negative. On one hand, as more people have access to health care, they
may improve their health behaviors with advice from medical professionals, educational materials,
tobacco cessation treatments, and healthy behavior incentive programs provided by Medicaid. On
the other hand, this increase in access can also lead to moral hazard where reduced costs of health
care through insurance can make individuals choose less healthy behaviors. Objectives In this study, I
asked whether the ACA changed risky health behaviors.
Methods
I used a difference-in-difference-in-differences regression model where time, state
Medicaid expansion status, and local area pre-ACA uninsured rate together constituted my
identification strategy. In all my models, I controlled for a large set of individual-level and area-
specific variables.
Results I did not find any statistically significant negative effects on risky health behaviors that would
have supported the existence of moral hazard that dominates other effects. On the other hand, I
found significant improvements in smoking and excessive drinking in 2017 and 2018. These results
are robust to using only the subsamples of poor childless adults and the newly insured.
Conclusions
Early effects of the ACA’s insurance coverage expansions did not lead to any significant
changes in risky health behaviors except for improvements in smoking and excessive drinking in 2017
and 2018. Further research is needed for the later years as more individuals became aware of these
benefits.
Kilchenstein, D., Banta, J. E., Oh, J., & Grohar, A. (2022). Cost barriers to health services in
U.S. adults before and after the implementation of the Affordable Care Act.
Cureus
,
14
(2). https://doi.org/10.7759/cureus.21905
Background: The Affordable Care Act (ACA) was passed in 2010 and implemented in 2014 in the
United States (U.S.). It was partly intended to reduce the cost burden to health coverage and care.
Objective: To determine if ACA implementation reduced the odds of experiencing cost barriers to
needed healthcare services for vulnerable groups.
Methodology: National Health Interview Survey Data from the Integrated Public Use Microdata Set
(2011-2013; 2015-2017) were used to examine cost barriers to primary health, mental health, dental
services, and prescription medications particularly for adults living in poverty, those of color, and
unmarried individuals before and after implementation of the ACA. The study sample included
112,245 individuals, representing an annual average of 138 million adults (aged 26 to 64 years of
age), including 59,367 survey respondents from 2011 to 2013 and 52,878 from 2015 to 2017.
Results: Pre/post-ACA, cost barriers to medical care decreased from 9.6% to 7.0% of adults, mental
care from 3.0% to 2.4%, dental care 15.0 to 11.7%, and prescriptions from 9.9% to 7.0% (all
comparisons p<.001). Survey design-adjusted regression results indicated significant decreases in the
odds of experiencing cost barriers to physical, mental, dental health services and prescription
medications after the implementation of the ACA for people living under 200% poverty, unmarried
adults, and people of color. While the race was not a substantial barrier post-ACA, living in poverty
and being unmarried remained the biggest predictors of cost barriers to services. Cost barriers for all
services increased post ACA for adults with private coverage, and among older adults for prescription
and dental services.
Conclusions: While the ACA was largely successful in reducing the number of uninsured adults in the
U.S., remaining barriers suggest the need to strengthen the ACA and reduce cost barriers to
healthcare services for everyone.
Gross, J., & Gordon, D. B. (2019). The Strengths and Weaknesses of Current US Policy to
Address Pain.
American Journal of Public Health
,
109
(1), 66–72.
https://doi.org/10.2105/ajph.2018.304746
Pain is a significant public health problem that needs policy at the national and local level to resolve
incidents of insufficient, ineffective, and disparate pain treatment while limiting the risk of
inadvertently increasing the use of treatment such as opioids that can result in public harm.The
National Pain Strategy serves as the first comprehensive approach to address pain and provides a
roadmap with substantial broad and specific policy implications. Although much has been
accomplished to date, transitions in political power, available data and funding, and the current
opioid epidemic continue to have an impact on implementation of the National Pain Strategy.A
sustained, coordinated effort with multipronged policies in many forms on both federal and state
levels via regulations, laws, and guidelines is warranted. However, research is needed to evaluate the
impact and potential unintended consequences of increased legislation and regulation. Nevertheless,
policy related to the management of pain may provide the path to new treatments and models of
care to reduce the impact of pain as a public health crisis in this country.
ARP
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