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Our World

January 4, 2014

Four ways to tell if Affordable Care Act is working

(Continued)

WASHINGTON — Do Americans have better access to health care?

Insurance cards, on their own, are not very much fun. In fact, they're probably among the more boring pieces of plastic you own. Nobody pays hundreds of dollars each year in premiums to get a small plastic card; they do it for the access that card gives to insurance coverage. So another metric to measure the ACA is whether Americans have an easier time seeing the doctor, for example, or meeting their medical needs without financial hardship.

This is true both for those gaining coverage under the health law and for those who already have it. One metric researchers were really interested in comes from Massachusetts, where they can measure what happened to those who already had coverage when many more people gained access to it. They can look at this by researching wait times to see doctors and surveying the general population about whether they can afford the care they need more easily. A much-watched study of Oregon's Medicaid expansion -- where coverage was assigned randomly, by lottery -- was one example where researchers showed a reduction in financial hardships when Oregonians enrolled in the public program.

Are Americans getting healthier?

The whole idea of health insurance -- as the name pretty bluntly implies -- is improving health. That's why this is another metric that will likely be tracked with the ACA, whether the insurance expansion is making the population healthier.

Proving a link between health insurance coverage and health status improvement can be challenging. Trips to the doctor are, obviously, only one factor among dozens that contribute to an individual's physical well-being. That same study of the Oregon Medicaid expansion showed a 30 percent reduction in depression rates, but found no short-term impact on physical health measures, such as cholesterol and blood pressure.

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