From the Guidelines
The healthcare policy in the USA from 2016 to 2020 prioritized dismantling the Affordable Care Act (ACA) and implementing market-oriented reforms, which had a mixed impact on morbidity, mortality, and quality of life, particularly for individuals with diabetes and substance use disorders. The Trump administration's efforts to reduce the individual mandate penalty to zero, expand access to short-term limited-duration insurance plans, and promote association health plans as alternatives to ACA marketplace coverage led to slightly declining insurance rates and continued challenges with healthcare affordability for many Americans 1. However, the administration's expansion of telehealth access, particularly during the COVID-19 pandemic, and implementation of the "Patients Over Paperwork" initiative to reduce regulatory burdens on providers may have improved access to care for some individuals 1. A more recent study published in 2023 highlights the importance of access to affordable health care for people at risk for or with diabetes, and recommends that federal policies and programs be designed to ensure that all people at risk for and with diabetes have access to comprehensive, high-quality, and affordable health care 1. Key aspects of the healthcare policy during this period include:
- Expansion of access to short-term limited-duration insurance plans
- Promotion of association health plans as alternatives to ACA marketplace coverage
- Implementation of work requirements for Medicaid in several states
- Prescription drug pricing reform through executive orders
- Expansion of telehealth access, particularly during the COVID-19 pandemic
- Implementation of the "Patients Over Paperwork" initiative to reduce regulatory burdens on providers
- Continued challenges with healthcare affordability for many Americans, particularly those with diabetes and substance use disorders. Overall, the healthcare policy in the USA from 2016 to 2020 had a mixed impact on morbidity, mortality, and quality of life, and further efforts are needed to ensure that all individuals have access to comprehensive, high-quality, and affordable health care 1.
From the Research
Overview of USA 2016-2020 Healthcare Policy
- The Affordable Care Act (ACA) was a significant overhaul of the US healthcare system, aiming to expand access to care, improve quality, and reduce healthcare costs 2.
- The ACA has had a positive impact on health equity, reducing social disparities in key healthcare outcomes, including insurance coverage, healthcare access, and the use of primary care 3.
Impact on Healthcare Access and Self-Assessed Health
- The ACA has improved healthcare access and self-assessed health, with continued gains in coverage and reported excellent health during 2017 and 2018 4.
- The Medicaid expansion has had a significant impact on reducing social disparities in health outcomes, including preterm births and mortality 3.
Effects on Vulnerable Communities
- The ACA Medicaid expansions have increased insurance coverage among racial/ethnic minorities, immigrants, single mothers, veterans, and low-education whites 5.
- However, the benefits of the ACA have not been evenly distributed across these subgroups, with low-education whites, non-Hispanic whites, females, and non-Hispanic Native Americans exhibiting the highest improvements in insurance coverage 5.
Racial and Ethnic Disparities in Health Insurance Coverage
- The ACA has decreased disparities in health insurance coverage related to race and ethnicity, with coverage increasing more for non-Hispanic blacks and Hispanics than for non-Hispanic whites 6.
- Despite these improvements, a large number of adults remain uninsured, and the uninsurance rate among blacks and Hispanics is substantially higher than the rate among whites 6.