0119-News-ACA analysis_Blog

More than 6 million uninsured Americans at risk for heart disease and stroke gained health insurance in 2014, the first year coverage was available under the Affordable Care Act. Many more with a history of heart disease and stroke also became insured.

The analysis, released Tuesday and commissioned by the American Heart Association, comes from the Center for Health Policy Research in the Milken Institute School of Public Health at George Washington University. Researchers used federal data to identify how many people with cardiovascular risk factors – high blood pressure, high cholesterol, diabetes, smoking, overweight or obesity – lacked health insurance in 2013 compared with 2014.

Among at-risk adults under 65, the number of uninsured fell by 6.2 million, from 31 million to 24.8 million. In addition, more than 100,000 stroke survivors gained coverage, as did nearly 250,000 people with a history of heart disease and more than 950,000 people with a history of high blood pressure.

Uninsured rates fell most steeply among African-Americans. For example, the percentage of uninsured African-Americans with high cholesterol fell by more than half between 2013 and 2014, compared with a quarter drop among Hispanics and a third decline among whites.

The study’s lead researcher Leighton Ku, Ph.D., said the expansion in coverage is improving access to preventive and primary care and is helping people who suffer “catastrophic events” like heart attacks and strokes. He noted, however, that it is too soon to know how the ACA’s insurance reforms will translate into better health in the long-term for people at risk for or living with cardiovascular disease.

“It will take more time to look at changes in health outcomes, like heart attacks or blood pressure levels, because it takes longer for these to manifest,” said Ku, director of George Washington University’s Center for Health Policy Research. Heart attack rates, for example, are affected by years of accumulated risk, he said.

Among the preventive services covered under the ACA at no cost to the patient are blood pressure and cholesterol screenings, smoking cessation services and behavioral counseling for obesity.

Although Ku’s study did not evaluate whether being insured changed the use of medical services, other research suggests people who are adequately insured are more likely to seek treatment and have better outcomes.

A 2011 Oregon study found that low-income adults receiving Medicaid were more likely to have an outpatient visit and to take medications prescribed by a doctor than those without Medicaid. A 2012 study found that death rates dropped in several states that expanded Medicaid coverage compared with several states that did not expand Medicaid.

Overall, the rate of uninsured U.S. adults under 65, regardless of their cardiovascular status, has continued to decline: from 39.6 million in 2013 to 24.9 million for the first half of 2015, according to the Centers for Disease Control and Prevention.

Open enrollment under the ACA ends Jan. 31.