Health Outcomes and Access to Care According to Type of Insurance Coverage: Implications for the Affordable Care Act

The objective of this study is to examine the differences in health outcomes and access to care indicators between different types of coverage status: individuals who are covered privately, publicly, and the uninsured who are likely to qualify for coverage under the Affordable Care Act (ACA). Data were from the 2012 Medical Expenditure Panel Survey (MEPS) and analyzed separately for the types of insurance status: the privately insured (n=9,315), the publicly insured (n=2,323), the uninsured who would be likely to be required to purchase health insurance through the exchanges (RPIE; n=2,863), and the uninsured who would be likely to be eligible for Medicaid expansion (EME; n=2,133). Bivariate analysis shows that the publicly insured reported worse health outcomes than the privately insured, RPIE, and EME on most health indicators despite better access to care. In the group comparison within the insured and uninsured, multiple logistic regression results indicate that all prevalence of chronic conditions except cancer differed significantly between the privately insured and publicly insured population, while it did not between RPIE and EME. The differences were especially pronounced for unmet health needs, women’s screenings, and mental health between RPIE and EME. However, those differences were not statistically significant after controlling for sociodemographic characteristics. Based on our results, it appears that the general health outcomes of those who are publicly insured are the worst despite the highest healthcare accessibility and utilization. Findings suggest that increased access to healthcare with the Medicaid expansion under the ACA may not play as significant a role improving the general health status among the uninsured as much as anticipated.