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.

  1. Martin De Rita, LCSW 2 years ago

    I wish your findings would become more publicized on Social Media and the major News Networks. They all seem to shy away from reporting Positives about the ACA. Even PBS seems to shy away and slight ACA, and they seem to enjoy pointing out only the negatives.

    Martin De Rita, LCSW. BCD

  2. F.Douglas Stephenson, LCSW,BCD 2 years ago

    Alas, the “key” to improved health will not be found in the current ACA.The U. S. continues to fare poorly in quality, access, efficiency, affordability, and equity of care compared to other advanced countries around the world. The ACA built on a flawed financing system, which will be unsustainable for patients, families and taxpayers. There is an alternative—single payer national health insurance, improved Medicare for all, coupled with a private delivery system, the principles of which were laid out more than 20 years ago. Please read this brief summary of H.R. 676 .”The Expanded and Improved Medicare for All Act” where the real key to improvement will be found!

    H.R. 676, “The Expanded & Improved Medicare For All Act”


    H.R. 676 establishes a unique American universal health insurance program with single-payer financing. The bill would create a publicly financed, privately delivered health care system that improves and expands the already existing Medicare program to all U.S. residents, and all residents living in U.S. territories. The goal of the legislation is to ensure that all Americans will have access, guaranteed by law, to the highest quality and most cost effective health care services regardless of their employment, income or health care status. In short, health care becomes a fundamental human right, with no financial barriers or financial harm resulting from seeking care. With 42 million uninsured Americans, and many millions more who are underinsured, the time has come to change our inefficient and costly fragmented non-system of health care. The current for-profit health care system in the U.S. is not financially sustainable over the long run, hence the need for a unique nonprofit, universal single-payer health care system.

    Who is eligible

    Every person living or visiting in the United States and the U.S. Territories would receive a “Medicare For All Card” and ID number once they enroll at the appropriate location. Social Security numbers may not be used when assigning ID cards.

    Health care services covered

    This program will cover all medically necessary services, including primary care, medically approved diet and nutrition services, inpatient care, outpatient care, emergency care, prescription drugs, durable medical equipment, hearing services, long term care, palliative care, podiatric care, mental health services, dentistry, oral surgery, eye care, chiropractic, and substance abuse treatment. Patients have their choice of physicians, providers, hospitals, clinics, and practices. There are no co-pays or deductibles allowed under this act.

    Conversion to a nonprofit health care system

    Doctors, hospitals, and clinics will continue to operate as privately entities. However, they will be unable to issue stock. Private health insurers shall be prohibited under this act from selling coverage that duplicates the benefits of the Improved Medicare For All program. Exceptions to this rule include coverage for cosmetic surgery, and other medically unnecessary treatments. Those workers who are displaced as the result of the transition to a nonprofit health care system will be the first to be hired and retrained under this act. Furthermore, workers would receive their same salary for up to two years, and would then be eligible for unemployment benefits. The conversion to a not-for-profit health care system will take place as soon as possible, but not to exceed a 15-year period, through the sale of U.S. Treasury bonds.

    Cost containment provisions/ reimbursement

    The Improved Medicare for All program will negotiate reimbursement rates annually with physicians, allow for global budgets (monthly lump sums for operating expenses) for hospitals, and negotiate prices for prescription drugs, medical supplies and equipment. A “Medicare for all Trust Fund” will be established to ensure a dedicated stream of funding. An annual congressional appropriation is also authorized to ensure optimal levels of funding for the program, in particular, to ensure the requisite number of physicians and nurses need in the health care delivery system.

    Families and individuals will pay less

    Currently, health care costs for a typical family of four in the most common health plan offered by employers are an average of $8,584 a year — $5,114 in premiums and another $3,470 in out-of-pocket medical services, drugs, and supplies. Employers pay an additional $12,144 towards the coverage, for a total cost per family of $20,728 (Milliman Medical Index, Fiscal studies by economists Dean Baker (2007) and Gerald Friedman (2013) have estimated that under H.R. 676, 95 percent of U.S. households would be paying less than they now for all health care costs. Most businesses would pay less too.

    Containing annual health care costs, while covering all Americans

    Savings from reduced administration, bulk purchasing, and coordination among providers will allow coverage for all Americans while reducing health care inflation in the long term. Annual savings from enacting H.R. 676 have been estimated at $387 billion (Baker, 2008) to $592 billion (Friedman, 2013).

    Proposed funding for the Improved Medicare for All program

    ¨ Maintain current federal funding for health care.

    ¨ Increase personal income tax on the top 5 percent of income earners

    ¨ Institute a modest and progressive excise tax on payroll and self-employment income.

    ¨ Instituting a modest tax on unearned income.

    ¨ Institute a small tax on stock and bond transactions.

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