Coverage is linked with significant improvements in access to care, chronic disease management, well-being and survival.
Health insurance coverage improves access to care and health status, according to a recent review of research over the past decade.
“We know far more now about the effects of health insurance than we did when the (Affordable Care Act) originally passed, due to many recent high-quality studies,” said Dr. Benjamin Sommers, one of three professors at the Harvard T.H. Chan School of Public Health who did the new analysis.
“The evidence we reviewed in this paper shows that coverage makes a major difference in people’s ability to live healthier and longer lives,” Sommers said.
The other authors were surgeon and writer Dr. Atul Gawande and health economist Katherine Baicker. The results were published in June in The New England Journal of Medicine.
The data suggest that policies that reduce coverage will produce significant harms to health.
The researchers concluded that health insurance coverage is linked with significant improvements in access to care, chronic disease management, well-being and survival.
Gaining health coverage has meant people are more likely to have a usual source of care and better able to afford to pay for care. They’re also more likely to use primary care and preventive services and take their medication as instructed.
There was mixed evidence on whether the use of emergency rooms spiked when coverage expanded. The authors note that increased ER use could mean people are using “low-value” care because of poor access to primary care—but also that people are getting critical care.
People with chronic illnesses like diabetes or depression are a “vulnerable and high-cost population,” but the effects of health coverage vary among diseases, people and delivery systems, according to the study authors.
Coverage expansions led to more people getting diagnosed with diabetes and taking diabetes medication. However, the coverage did not seem to improve blood pressure or cholesterol levels.
One widely reported study of Medicaid expansion in Oregon suggested the coverage was especially helpful for people with depression. The study showed increased diagnosis and treatment with antidepressants, as well as a reduction in the rate of symptoms of depression.
People’s impressions of their own physical and mental health improve after they gain health insurance, the studies showed. This self-reported health “squarely fits within the World Health Organization’s definition of health … [and] is also a primary goal of much of the medical care delivered by health care professionals,” the authors write in the paper.
Expanding health care coverage can even reduce death rates, according to the research review. One study showed that three states that expanded Medicaid coverage in the early 2000s saw mortality fall 6% over five years compared with neighboring states that didn’t expand coverage. Another study found one life was saved for every 239 to 316 people who gained Medicaid coverage under the Affordable Care Act.
“The data suggest that policies that reduce coverage will produce significant harms to health, particularly among people with lower incomes and chronic conditions,” the authors wrote. “Arguing that health insurance coverage doesn’t improve health is simply inconsistent with the evidence.”