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Is the Affordable Care Act Actually Making People Healthier?

ACA.jpgThe Affordable Care Act remains controversial and faces an uncertain future under the Trump administration. One of the many controversial aspects of the ACA is the individual mandate:

“People, for reasons of their own, often fail to do things that would be good for them or good for society.”

Supreme Court Chief Justice Roberts made that statement in 2012 as part of the Court’s ruling on the constitutionality of the ACA’s individual mandate. The idea of being forced to pay for a product one does not want can leave a bitter taste in one’s mouth — especially in a country that has historically espoused freedom — but has the ACA been achieving its societal goals?

Some studies suggest that the Affordable Care Act and the expansion of Medicaid insurance have had positive impacts on health and medical debt. But do these studies tell the whole story? After all, other factors, such as more effective patient engagement, can also play a role. Let’s take a closer look.


▶ Whom does the individual mandate impact?

The Affordable Care Act individual mandate requires that most individuals must have health insurance that meets minimum standards of coverage. Those who fail to maintain such coverage face a penalty—or tax, according to the Supreme Court.

Of course, there are exceptions. Exemptions to the mandate include:

  • Individuals with incomes below 138 percent of poverty in states that did not expand Medicaid eligibility under the ACA;
  • Individuals with incomes so low they are not required to file taxes or who face other hardships;
  • Individuals who would spend more than 8.13 percent of their household incomes for insurance after employee contributions or subsidies;
  • People who are incarcerated, undocumented immigrants, members of Native American tribes and members of any religion opposed to accepting benefits from a health insurance policy.

People who don’t qualify for exemptions to the individual mandate face tax penalties calculated as either a percentage of household income or a fee per person in the household, whichever is higher.


▶ Where is the ACA having a positive impact?

Millions of people gained health insurance coverages as a result of the Affordable Care Act.  But as with any major program, it takes time to accumulate meaningful data that demonstrates its value—or lack of it.

Recently, however, The New York Times reported that: “A few recent studies suggest that people have become less likely to have medical debt or to postpone care because of cost. Uninsured_rate.jpgThey are also more likely to have a regular doctor and to be getting preventive health services like vaccines and cancer screenings.”

The article cites a study published in JAMA Internal Medicine that compared individuals in two states that expanded Medicaid with those in a state that didn’t, to see if having health coverage makes a discernible difference.

The study found that people in Arkansas and Kentucky—the states with expanded Medicaid coverage—were 5 percent more likely to say they were in excellent health than their counterparts in Texas, a non-expansion state.

Those in the expansion states were also more likely to:

  • Have a designated doctor for when they need care
  • Seek treatment for a chronic disease
  • Receive health screenings for common markers of heart disease and diabetes

They were also less likely to postpone care or avoid medication adherence due to cost. This isn’t the only study to reveal that people with insurance feel more positive about their own health and face less financial insecurity related to medical bills. But the findings of a study in Oregon found that health insurance did not impact certain health measure like blood pressure or cholesterol as much as hoped.

Health Affairs data analysis found the pool of uninsured and Medicaid-covered individuals actually become healthier, while insured individuals—as a group—experienced a decline. This has a lot to do with the fact that sicker people left the uninsured pool because pre-existing conditions stopped being a barrier to coverage. It also may reflect that younger, healthier individuals are willing to pay the penalty, which is most cases is far less costly than an insurance plan.


Moreover, while newly insured people have access to some degree of coverage, this does not mean they have access to health care. Individuals on exchange Silver plans pay twice as much out of pocket costs for prescription drugs as individuals with employer sponsored plans.  Furthermore, as the pool of primary care physicians continues to shrink while more patients are insured, it becomes more challenging to secure timely doctor appointments.


▶ Motivating Healthy Behaviors Remains Crucial

As noted above, health insurance alone does not lead to improved health. Certainly, it opens the door, encouraging individuals to seek out needed health screenings and care for chronic conditions. But let’s face it: Getting a doctor’s advice and actually following it are two different things. To make real progress on improving the health of individuals—and populations—healthcare providers and insurers need to understand what makes people tick to influence healthy behaviors.  

Psychographic segmentation can provide insights that maximize healthcare consumer engagement, whether you’re trying to attract healthcare consumers to an insurance plan or trying to inspire adherence to medical advice. Understanding attitudes about the Affordable Care Act’s individual mandate, beliefs about health and wellness, and what motivates individuals to pursue better health, enables organizations to fine-tune their messaging so it speaks to target audiences on a more personal level to drive engagement. And that’s a critical part of the journey to a healthier America.

Psychographic Segmentation and its Practical Application in Patient Engagement and Behavior Change


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