Changes In Health Insurance Coverage, Access To Care, And Income-Based Disparities Among US Adults, 2011-17

Health Aff (Millwood). 2020 Feb;39(2):319-326. doi: 10.1377/hlthaff.2019.00904.


The Affordable Care Act increased insurance coverage and access to care, according to numerous national studies. However, the administration of President Donald Trump implemented several policies that may have affected the act's effectiveness. It is unknown what effect these changes had on access to care. We used survey data for 2011-17 from the Behavioral Risk Factor Surveillance System to assess changes access to care among nonelderly adults from before to after the change in administration in 2017. We found that the proportion of adults who were uninsured or avoided care because of cost increased by 1.2 percentage points and 1.0 percentage points, respectively, during 2017. These changes were greater among respondents who had household incomes below 138 percent of the federal poverty level, resided in states that did not expand eligibility for Medicaid, or both. At the population level, our findings imply that approximately two million additional US adults experienced these outcomes at the end of 2017, compared to the end of 2016.

Keywords: Access to Care; Affordable Care Act; Behavioral Risk Factor Surveillance System; Health disparities; Health insurance exchanges; Health policy; Insurance coverage and benefits; Medicaid; Private health insurance; Socioeconomic disparities.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Health Services Accessibility*
  • Humans
  • Insurance Coverage
  • Insurance, Health
  • Medicaid
  • Medically Uninsured
  • Patient Protection and Affordable Care Act*
  • United States