ACA Improved Uninsurance Rates in COPD and Asthma, But Not Affordability

While the Affordable Care Act (ACA) effectively reversed coverage losses for patients with airway disease, neither care affordability nor disparities improved for these patients, according to study results in CHEST.

Researchers conducted an analysis of time-trends in health coverage and medical care and drug affordability data from the 1997 to 2018 National Health Interview Survey. Data were included for adult patients with asthma and chronic obstructive pulmonary disease (COPD) both overall and stratified by income and race and ethnicity. A total of 76,843 adults with asthma and 30,548 with COPD were included in the final analysis.

According to the survey data, uninsurance rates rose during the first decade of the 21st century among adult patients with asthma. The overall uninsurance rate for adults with asthma was 16.8% in 1997 vs 12.6% in 2000 and then 17.6% in 2009. The rate of uninsurance in these patients decreased to a nadir of 7.6% in 2016 following the implementation of the ACA.

The uninsurance rate for asthma decreased overall from 19.43% in 1997 to 9.62% in 2018 (adjusted 9.27 percentage points; 95% CI, 7.01-11.46; P <.001). The implementation of the ACA, according to adjusted analyses, was associated with a significant 7.15% decrease in the uninsurance rate in adults with asthma (95% CI, -8.50 to -5.81; P <.001).

Delayed/forgone medical care and forgone prescriptions medications because of costs rose rapidly during the first decade of the 21st century and fell in the second decade, but there was no significant change in either outcome between 1997 and 2018. The investigators observed persisting racial and ethnic and economic disparities over time.

In patients with COPD, the rate of uninsurance decreased by an adjusted 7.05 percentage points (95% CI, -9.57 to -4.53) following the implementation of the ACA, corresponding with an adjusted decline of 9.48 percentage points (95% CI, -5.67 to-13.28) between 1997 and 2018. The percentage of patients with COPD delaying or skipping care because of cost, however, increased nonsignificantly over the 22-year study period from 16.68% to 19.32%. Additionally, the percentage of patients with COPD foregoing medications because of cost significantly increased 11.49% to 18.12% (adjusted 7.78 percentage point increase; 95% CI, 4.29-11.27).

A limitation of this study was the reliance on survey data, which included self-reported diagnoses rather than spirometry data or clinician-confirmed diagnoses.

The investigators concluded that these trends “shed light both on potential threats to the health of patients with airway disease during the current tumult and the potential benefits of policies to assure universal, comprehensive coverage.”

Reference

Gaffney AW, Hawks L, Bor D, et al. National trends and disparities in healthcare access and coverage among adults with asthma and COPD: 1997-2018. Published online January 23, 2021. CHEST. doi:10.1016/j.chest.2021.01.035