August 10, 2018 Kim Krisberg 0Comment

Another day, another study on the benefits of the Affordable Care Act. Actually, this time, it’s three more studies.

This month, Health Affairs published three new studies on ACA health and coverage gains — one found that the ACA’s Medicaid expansion widened access to addiction treatment, another found big insurance gains for self-employed Americans and workers without access to employer-sponsored health coverage, and a third found that more people are filling their diabetes prescriptions.

Let’s start with addiction treatment, since the worsening opioid epidemic is a problem the Trump administration says it cares about. In that study, researchers set out to measure the impact of the ACA’s essential health benefits rule, which requires that insurers and Medicaid expansion plans cover addiction treatment, as well as ACA parity rules that require equal coverage of mental and physical health care.

The study is based on Medicaid data from all 50 states and Washington, D.C., between 2014 and 2017. It found that the number of state Medicaid plans covering long- and short-term residential treatment as well as addiction medications such as methadone and oral naltrexone went up significantly after the ACA went into effect. For example, coverage of methadone increased from 33 state plans to 40. In addition, the number of states that imposed annual service limits on outpatient treatment went down by more than half, while fewer states required preauthorization for addiction care and medication. Interestingly, the study found access gains in expanded and traditional Medicaid, noting that the changes may be driven by both the ACA and as a response to the worsening opioid problem.

“The ACA may have prompted state Medicaid programs to expand addiction treatment benefits and reduce utilization controls in alternative benefit plans,” the study stated. “The trend was also observed among standard Medicaid plans not subject to ACA parity laws, which suggests a potential spillover effect.”

The next study on self-employed workers and workers without employer-sponsored coverage is based on 2010-2016 data from the National Health Interview Survey. Researchers found that post-ACA, uninsurance went down by nearly 7 percentage points among self-employed workers and more than 17 percentage points for wage-earners without employer coverage. Among workers without employer coverage, the uninsurance drop represented a nearly 30 percent decline relative to their near-60 percent chance of going uninsured in the years before the ACA. Researchers said the gains were likely attributable to expanded Medicaid eligibility and access to private insurance in the ACA marketplace.

“In addition to increasing coverage among workers without employer coverage offers, ACA provisions could reduce labor-market distortions in the long run by making it easier to maintain coverage while changing jobs, working part time, retiring before age 65 or being self-employed,” the study concluded.

The last Health Affairs study examined how the ACA Medicaid expansion changed access to diabetes medication. The study notes that diabetes is one of the country’s leading causes of death, with previous research finding that each additional treated person with diabetes can save thousands of dollars in hospital care. To conduct the study, researchers examined Medicaid insurance data on more than 96 million filled prescriptions between 2008 and 2015.

They found that Medicaid expansion was associated with 30 additional Medicaid diabetes prescriptions filled per 1,000 people in 2014-2015, compared to states where policymakers rejected Medicaid expansion. Prescription fills for insulin and newer diabetes medications increased by 40 percent and 39 percent, respectively. Newer diabetes medications, which pre-ACA came with substantially higher out-of-pocket costs, accounted for about one-third of the increase in prescriptions.

“Our findings by drug class suggest that these expansions helped address some of the gaps in access to newer medications for low-income patients,” researchers concluded. “An increase in access to newer medications may have important health effects, because the use of these medications has been linked with improved diabetes control and reduced symptoms in both clinical trials and observational data.”

Unfortunately, the White House is doing everything it can to undermine the ACA, even though a majority of Americans support the law and by most accounts, it’s working. Earlier this month, the Trump administration unveiled a final rule that expands the duration of short-term health plans from three months to a year, or a total of three years with renewals and extensions. Short-term plans don’t have to comply with ACA consumer protections, like coverage of pre-existing conditions, essential health benefits and bans on lifetime limits. So, in essence, Trump is creating a new marketplace of long-term, junk plans that health economists say will drive up premiums for insurance plans that actually cover the medical care people need without driving families into bankruptcy.

But, don’t worry. U.S. Health and Human Services Secretary Alex Azar said earlier this month that the short-term plan rule is only a stopgap — the long-term goal is still “repeal and replace.”

For copies of the three ACA studies, visit Health Affairs.

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