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AHRQ Report Shows Gains in Access to and Affordability of Health Insurance
By Ernest Moy, M.D., M.P.H., Medical Officer, and Barbara Barton, M.P.H., Health Scientist Administrator
AHRQ Center for Quality Improvement and Patient Safety
Today, more people are gaining health care coverage, have a usual place to go for medical care and can more easily afford medical bills due to the Affordable Care Act, an AHRQ report finds. The 2015 National Healthcare Quality and Disparities Report (QDR) and 5th Anniversary Update on the National Quality Strategy shows that our efforts to make health care more accessible, affordable, and equitable are making a difference.
The QDR features annual trends on more than 250 measures of quality, access, and disparities that cover a broad array of health care services and settings. Overall, the report shows that quality of care is improving, particularly in hospitals, and for measures that are being publicly reported by the Centers for Medicare & Medicaid Services. However, quality of care is still less than optimal overall for many Americans.
One area that showed sustained improvement was access to care. The overall rate of uninsured people under age 65 decreased from 18 percent in 2010 to 10 percent in the second quarter of 2015. For 18- to 29-year-olds, the uninsured rate declined even further —by more than half, from 31 percent to 15 percent. Among poor people ages 18-64, the uninsured rate fell from 44 percent to 25 percent. These are notable improvements that demonstrate how the Affordable Care Act is increasing access to care for disadvantaged groups. Between 2013 and the second quarter of 2015, there has been a significant decline in the percentage of uninsured blacks (24.6 percent to 13.5 percent) and Hispanics (40.3 percent to 26.1 percent). However, black and Hispanic adults ages 18-64 are still significantly more likely than whites to be uninsured.
In addition to gains made in health care coverage, the QDR also found that more people had a usual place to go for medical care. For blacks and Hispanics this measure increased overall, with Hispanics showing the biggest gains, jumping from 77 percent in 2010 to 83 percent in the first half of 2015.
The cost of health care coverage also became more affordable as fewer families reported having trouble paying medical bills within the past year. All racial and ethnic groups also saw a decline in payment issues during this period. Poor families showed the greatest benefit, with those reporting payment problems falling from 32 percent to 25 percent.
For the first time, this year’s report includes an update on the U.S. Department of Health and Human Services’ (HHS’) National Quality Strategy (NQS) at its 5-year anniversary mark. The NQS priorities are: making care safer, person- and family-centered care, effective communication and care coordination, prevention and treatment of leading causes of morbidity and mortality, health and well-being of communities, and care affordability. While the report shows progress for all of the priorities, improvement in care coordination is lagging. Established as part of the Affordable Care Act, the NQS is the first-ever national effort backed by legislation to align public- and private-sector stakeholders to achieve better care, healthy people/healthy communities, and more affordable care.
Last week, the Centers for Disease Control & Prevention released "Health, United States, 2015," the 39th annual report card on the nation’s health, along with a special feature on racial and ethnic health disparities. Together, this report and the 2015 National Healthcare Quality and Disparities Report and 5th Anniversary Update on the National Quality Strategy provide the most comprehensive assessment of health, health care, and disparities in the United States and track progress of the NQS toward better care, healthy communities, and smarter spending.
Making health care more affordable, accessible, and equitable for all remains a challenge—and one that AHRQ will continue to address.