Health insurance coverage before and after the Affordable Care Act

Inadequate research has examined the effect of the Affordable Care Act (ACA) on health insurance status in the United States after its full implementation as data were released only recently. This study analyzes changes in health insurance status and its determinants before the ACA, after its partial implementation in 2010-2013, and after its full implementation in 2014 and 2015. Data from the 2009-2015 National Health Interview Surveys are used to address the research problem and test the hypotheses for this study. The trend analysis shows that the national health insurance rate increased significantly from 82.2 percent in 2009 to 89.4 percent in 2015. The results of logistic regression analysis reveal that age, gender, race, marital status, nativity, U.S. citizenship status, education, and poverty level influenced health insurance status consistently before and after the Affordable Care Act. While the effects of several predictors were either identical or similar across years, holding other variables constant those aged 26 or younger, the foreign-born, Asians, and other races had greater odds of getting health insurance after the ACA than they did before the ACA; however, the likelihood of gaining health insurance for Hispanics and people living under poverty increased slightly during the partial implementation of the ACA but somewhat decreased after the full implementation of the ACA starting in 2014. The findings help assess the effectiveness of the ACA and have significant implications for the pending healthcare reform.