UCLA

Individuals aged 19-64 with chronic conditions are likely to lose coverage or be faced with unaffordable premiums and medical bills. Chronically ill people are more likely to require not only routine primary care visits but also specialized care. However, the unstable coverage and strict health insurance rules might lead to some of them having difficulties obtaining care for certain services. Several health insurance policies aimed at increasing the coverage of individuals aged 19-64, especially the patients with chronic conditions. This dissertation focused on two policies: the ACA Marketplaces subsidies which gives premium and cost-sharing subsidies to people earning between 139%-400% of the Federal Poverty Line (FPL) who enroll in ACA Marketplaces plans, and the IRS new policy on encourage insurers and employers to provide more primary care before deductibles for patients with chronic conditions enrolling in High Deductible Health Plans (HDHPs).. This study assessed the effectiveness of the two policies in increasing the access to care and healthcare utilization of previously uninsured individuals aged 19-64 with chronic conditions. A quasi-experimental study was conducted using the difference-in-differences (DID) design and data from the Medical Expenditure Panel Survey. In ordered to investigate the effectiveness of the policies, the dissertation compared the change in reported difficulties, physician visits, and hospitalization rates between the two groups before and after the implementation of the policies between the intervention group and the control group. Among patients with chronic conditions, the pre-post increase in the probability of having any doctor visits was 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. Previously uninsured patients also had a modest but significant increase in hospitalization rate compared with the control patients. However, there were no significant changes in health services utilization for diabetes patients enrolling in HDHPs before and after the new IRS’s policies. The dissertation indicated that 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.