(LOUISVILLE, Ky – March 16, 2017) The Affordable Care Act (ACA) significantly increased the number of Kentuckians covered by both private and public health insurance, improved access to health care, and reduced the number of Kentuckians who struggle with medical expenses, according to a report released today by the Foundation for a Healthy Kentucky. At the same time, the report showed little progress in health care quality and outcomes within the first years of ACA implementation; nor did most measures tracked by the Foundation in these areas decline, however.
“The ACA has led to clear progress for many Kentuckians in three of the five areas we tracked – insurance coverage, access to regular doctor visits and health care costs for families,” said Ben Chandler, president and CEO of the Foundation, which commissioned the independent study to determine the impact of the ACA over its first three years in the Commonwealth. “Generally speaking, measures where the ACA hasn’t yet led to progress are in health care quality and outcomes. Often, it takes longer to see these results; you don’t turn around low birth weights or lengthen average lifespans in a couple of years. Some measures appear to worsen at first, but could improve later ─ for example, rates of chronic disease may seem to increase at first, but some people probably already had these diseases and simply didn’t know until they could see a doctor to be diagnosed and treated. That kind of change improves Kentucky’s overall health and reduces health care costs down the road.”
Measures that Showed Progress
Chandler offered more detail: “Our uninsurance rate has dropped by more than half, more Kentuckians have a regular doctor, more have visited their doctors in the prior year, and fewer Kentuckians are delaying or skipping health care because they can’t afford it. Moreover, Kentucky has seen significant increases in the number of people covered by both public insurance ─ largely Medicaid ─ and by private insurance. And the increase is markedly higher than in states that did not expand Medicaid under the ACA.”
Other headway since Kentucky implemented the ACA as documented in the study include:
- Significant health insurance coverage gains across all ages (including children), income levels, and most racial and ethnic groups (Hispanic/Latino and Asian populations did not see significant increases);
- Fewer elderly Kentuckians delaying refills and skipping or reducing doses because of high drug costs;
- An increase of more than 500 percent in the number of covered substance abuse treatments through the Commonwealth’s Medicaid program;
- A drop in the percentage of Kentuckians having trouble paying medical bills from nearly half in 2012 to slightly more than one-third in 2015;
- Monthly premium payments for insurance plans Kentuckians purchased from the marketplaces set up under the ACA that are lower than U.S. premiums and those of most surrounding states; and
- An increase in colorectal cancer screenings.
Despite concerns, the study did not find evidence that the significantly larger number of Kentuckians with Medicaid and other health insurance made it harder to see a doctor. Nor did the study uncover an increase in average out-of-pocket spending on health care since 2012.
“Nearly 95 percent of Kentuckians could still find a doctor when they needed one,” Chandler said.
The benefits didn’t reach Kentuckians of all ages and income levels, however. Health care costs still kept both sicker and lower-income Kentuckians from getting the care they need.
Measures that Declined or Showed No Progress
Most of the quality-of-care indicators followed by the study have neither improved nor declined since the ACA was implemented, although three of the measures ─ the percentage of infants who were breastfed at discharge from the hospital, preventable hospitalizations due to hypertension and asthma, and colorectal cancer screenings ─ did show some progress. Preventable hospitalizations due to short-term complications from diabetes increased, however.
Also, while the adult smoking rate, one of the health outcomes tracked by the study, declined from 28.3 percent in 2012 to 26 percent in 2015, the rate for high school students stayed about the same.
Kentucky’s adult obesity rate rose from 31.3 percent in 2012 to 34.6 percent in 2015. The percentage of adult Kentuckians reporting a chronic disease also rose significantly from 2012 through 2014, but then dropped back down to the 2012 rate in 2015.
“Myriad factors contribute to health and it takes time to change the tide in health outcomes,” Chandler said. “In the long run, though, increased coverage, improved access and lower costs lead to better quality and outcomes. That’s why I’m grateful Kentucky continues to support Medicaid expansion. We all want to sustain the gains we’ve achieved under the ACA and see the long-term benefits of increased coverage and access.”
The Foundation’s study on the impact of the ACA in Kentucky was conducted by the State Health Access Data Assistance Center at the University of Minnesota. The Final Report, as well as all previous reports, are available here.
NOTE TO EDITORS AND REPORTERS: The Foundation will issue a series of shorter releases over the coming weeks detailing individual measures tracked by the report.
About the Foundation for a Healthy Kentucky
Since the Foundation opened its doors in 2001, it has invested nearly $26.7 million in health policy research and advocacy, as well as demonstration project grants across the Commonwealth. Funded by an endowment, the mission of the nonpartisan Foundation is to address the unmet health care needs of Kentuckians by developing and influencing health policy, improving access to care, reducing health risks and disparities, and promoting health equity. Follow the Foundation on Twitter, Facebook and YouTube, and visit our website at www.healthy-ky.org.
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Bonnie J. Hackbarth