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Editor's Comment
Access to Care
January 27, 2020

New Research on Access to Care and Unmet Health Needs in the United States from 1998 through 2017

Author Affiliations
  • 1Editor in Chief, JAMA Health Forum
  • 2Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
JAMA Health Forum. 2020;1(1):e200003. doi:10.1001/jamahealthforum.2020.0003

A new study published today in JAMA Internal Medicine looks back at access to care and unmet health needs in the United States over the past 2 decades,1 reprising an analysis that colleagues and I published in JAMA in 2000.2 As I explain in my commentary accompanying the new study,3 this report documents important gains in access to care since 2014 for adults with lower incomes after the Affordable Care Act expanded Medicaid and made subsidized private insurance available through the federal and state insurance exchanges. This study also highlights the large persistent disparities in access to care for adults who remain uninsured, along with an increase in cost-related barriers to care for middle- and higher-income adults who are typically covered by employer-sponsored insurance.

The new study underscores the benefits of the Affordable Care Act in reducing socioeconomic disparities in access to care through expanded insurance coverage.4 It also highlights, however, the growing burden of rising health care expenses for many adults with employer-sponsored insurance who represent about 60% of all nonelderly adults. From 2010 to 2018, the proportion of these adults enrolled in high-deductible health plans—defined by a deductible of at least $1350 for individual coverage and $2700 for family coverage—increased from 25% to 46%.4 More than half of those enrolled in such health plans lacked a tax-exempt health savings account that can substantially offset the out-of-pocket spending required by these plans.

Thus, despite the notable gains in access to care for approximately 20 million Americans since the Affordable Care Act was enacted in 2010,5 the rising costs of health care are likely to be a prominent concern for voters in the Presidential and Congressional election this year.

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Article Information

Open Access: This is an open access article distributed under the terms of the CC-BY License.

Correction: This article was corrected on July 22, 2020, to fix a reference link.

Corresponding Author: John Z. Ayanian, MD, MPP, Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Rd, Ann Arbor, MI 48109 (jamahealthforum@jamanetwork.org).

Hawks  L, Himmelstein  DU, Woolhandler  S, Bor  DH, Gaffney  A, McCormick  D.  Trends in unmet need for physician and preventive services in the United States, 1998 to 2017  [published online January 27, 2020].  JAMA Intern Med. 2020. doi:10.1001/jamainternmed.2019.6538PubMedGoogle Scholar
Ayanian  JZ, Weissman  JS, Schneider  EC, Ginsburg  JA, Zaslavsky  AM.  Unmet health needs of uninsured adults in the United States.   JAMA. 2000;284(16):2061-2069. doi:10.1001/jama.284.16.2061PubMedGoogle ScholarCrossref
Ayanian  JZ.  Looking back to improve access to health care moving forward  [published online January 27, 2020].  JAMA Intern Med. 2020. doi:10.1001/jamainternmed.2019.6764PubMedGoogle Scholar
Cohen  RA, Terlizzi  EP, Martinez  ME. Health insurance coverage: early release of estimates from the National Health Interview Survey, 2018. National Center for Health Statistics. https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201905.pdf. Published May 2019. Accessed January 10, 2020.
Goldman  AL, Sommers  BD.  Medicaid expansion gains momentum: postelection prospects and potential implications.   JAMA. 2019;321(3):241-242. doi:10.1001/jama.2018.20484PubMedGoogle ScholarCrossref