OBJECTIVES: Nonelderly adults with chronic conditions are likely to lose coverage or be faced with unaffordable premiums and medical bills. The ACA gives premium and cost-sharing subsidies to people earning between 139%-400% of the Federal Poverty Line (FPL) who enroll in ACA Marketplaces plans. This study assessed the effectiveness of subsidies in increasing the access to care and healthcare utilization of previously uninsured nonelderly adults with chronic conditions.

METHODS: We conducted a quasi-experimental study using the difference-in-differences (DID) design and panel data from the 2013-14 Medical Expenditure Panel Survey. Our study cohort is nonelderly adults with chronic conditions who were eligible for subsidies. They were divided into two groups: (1) intervention group: individuals who were uninsured in 2013 (2) control group: individuals who enrolled in employer-sponsored health insurance plans in 2013. We compared the change in reported difficulties, physician visits, and hospitalization rates between the two groups before and after the implementation of the subsidies, which were available in 2014. Regression results controlled for demographic and health status variables.

RESULTS: Among patients with chronic conditions, the pre-post increase in the probability of having any doctor visits was 11.1 percentage points higher (p<0.05) for intervention patients (those who were previously uninsured) than control patients (those who were already insured); however, no significant associations were found with self-reported difficulties accessing care or total number of doctor visits. The DID estimate was larger for the previously uninsured patients receiving both premium and cost-sharing subsidies (17.3 percentage points, p<0.05). Previously uninsured patients also had a modest but significant increase in hospitalization rate (4 percentage points, p<0.05) compared with the control patients.

CONCLUSIONS: The ACA Marketplaces subsidies increased the healthcare utilization of previously uninsured patients with chronic conditions, primarily due to an increased likelihood of accessing any care.