Coverage for Chronically Ill Rose 5% Under ACA

About half of adults have more than one chronic medical condition.

About four million previously uninsured Americans with a chronic illness gained health insurance coverage after the Affordable Care Act went into effect in 2010, according to a recent analysis.

The study was published online Jan. 24 in the Annals of Internal Medicine.

Coverage for people chronic illnesses like heart disease, diabetes, arthritis, asthma, and other long-term health problems increased by about five percentage points after the ACA, says Elisabeth Poorman, MD, MPH, an internist with Cambridge Health Alliance in Cambridge, MA. She is one of the study's authors.

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About half of adults have more than one chronic medical condition, so Poorman and her colleagues reviewed data from the Behavioral Risk Factor Surveillance System, an annual survey conducted by the U.S. Centers for Disease Control and Prevention to see if Obamacare helped these people obtain insurance and gain regular access to medical care.

The researchers analyzed the responses of more than 600,000 adults with at least one chronic disease in the year before and the year after the ACA was implemented.

States that expanded Medicaid under Obamacare experienced a larger increase in coverage of the chronically ill, the study authors found. On average, Medicaid-expansion states increased coverage by almost six percentage points, from 82.8% with insurance before the ACA to 88.5% after the law went into effect, the findings showed.

But even states that didn't expand Medicaid experienced an increase, rising 4.2 percentage points from 77% before to nearly 82% after the ACA was enacted. However, nearly one in seven of those with a chronic disease still lacked coverage, including 20% of chronically ill black patients and one third of chronically ill Hispanics, the researchers found.

The Affordable Care Act's reforms also significantly increased the percentage of chronically ill people who could afford a doctor's visit and who had a check-up within the past year, the study found. But the law did not significantly improve chronically ill people's ability to establish an ongoing relationship with a primary care physician, Poorman said.

"Getting people connected with a primary care doctor is a longer-term, more intensive effort than getting people covered," she said.

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Poorman also noted that the chronically ill may be unable to gain coverage if they lose their current plan, Poorman said.

"If you have coverage under your employer and you lose your job, when you re-apply for new insurance you will not be able to qualify for coverage if you have a pre-existing condition," Poorman said. "The people who need care the most are probably going to be the least likely to get it."