Three essays on effects of the Affordable Care Act insurance expansions on access to care and health status

The Affordable Care Act (ACA) is the largest healthcare reform initiative since the 60s. Although the ACA aimed to increase coverage for the millions of uninsured, specific demographic groups such as the 50-64-year-olds remained particularly vulnerable in terms of coverage and health status. High prevalence of chronic diseases and pre-existing conditions are some of the reasons why this age group faced higher premiums and lack of coverage prior to the ACA. The ACA had several provisions that might increase coverage and therefore demand for care, and it is of interest to understand how primary care providers met the increased demand for care. Provider supply policies such as Nurse Practitioner (NP) Scope of Practice (SOP) Laws interacted with the ACA, and it is important to understand how measures of access to care and health status were affected accordingly.

This dissertation fills a gap in the literature and provides evidence on effects of the ACA on access to care and health status for the age group that is nearing Medicare age eligibility. The first aim of this dissertation is to examine differences in effects of the ACA Medicaid expansion on access to care and health status by state NP SOP laws. In aim two, effects of the ACA Medicaid expansion on access to care and health status of those aged 60-64. Aim three examines effects of the overall ACA on access to care and health status of those aged 50-64.