ECONOMIC REPORT OF THE PRESIDENT

percent during the decade preceding the ACA’s passage, with particularly
sharp increases coinciding with the onset of the Great Recession. By contrast,
since 2010, the overall share of individuals reporting these types of
affordability problems has declined by more than a third, returning to levels
last seen 15 years ago.
The recovery from the Great Recession has likely played some role
in reducing cost barriers to accessing care, as increased employment and
rising wages have reduced financial stress on families. However, the fact
that this measure is now so far below its pre-recession trend, combined with
the particularly sharp declines seen after 2013, strongly suggests that recent
coverage expansions are playing an important role. Consistent with that
interpretation, Figure 4-12 looks across states and demonstrates that states
experiencing larger reductions in their uninsured rates from 2013 to 2015
experienced larger reductions in the share of individuals reporting difficulty
accessing care due to cost. State-level data show that larger coverage gains
are also strongly associated with increases in the share of individuals with
a personal doctor and the share of individuals with a checkup in the last 12
months, as shown in Figure 4-13.
Researchers using other survey data sources have documented similar
sharp improvements in access to care as the ACA’s coverage provisions have
taken effect. For example, examining data through March 2015, Shartzer,
Long, and Anderson (2016) report that the share of non-elderly adults with a
usual source of care and the share who received a routine checkup in the last
12 months has risen alongside insurance coverage, while the share reporting
problems accessing care or forgoing care due to cost has fallen. Examining
a similar time period, Sommers et al. (2015) report reductions in the share
of non-elderly adults reporting that they lack easy access to medicine, lack a
personal physician, or are unable to afford care. As with the trends reported
in Figure 4-12 and Figure 4-13, the pattern of the access gains reported
in these studies is consistent with their having been caused by the ACA’s
coverage expansion. Both studies cited above, as well as Simon, Soni, and
Cawley (2016) and Wherry and Miller (2016), document that gains in access
to care have been largest in states that expanded their Medicaid programs.
Similarly, Shartzer, Long, and Anderson (2016) find that low- and moderate-income
adults, who saw the largest coverage gains, also saw the largest
improvements in access to care.
Better Health Outcomes
The ultimate goal of expanding access to health care services is
improving health. Research examining prior coverage expansions that targeted
populations similar to those targeted under the ACA provides a basis
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