Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Health Insurance Coverage Before and After the Affordable Care Act

Version 1 : Received: 16 April 2019 / Approved: 8 May 2019 / Online: 10 June 2019 (00:00:00 CEST)

A peer-reviewed article of this Preprint also exists.

Patrick, J.; Yang, P.Q. Health Insurance Coverage before and after the Affordable Care Act in the USA. Sci 2021, 3, 25. Patrick, J.; Yang, P.Q. Health Insurance Coverage before and after the Affordable Care Act in the USA. Sci 2021, 3, 25.


The Affordable Care Act (ACA) is at the crossroads. It is important to evaluate the effectiveness of the ACA in order to make rational decisions about the ongoing healthcare reform, but existing research into its effect on health insurance status in the United States is insufficient and descriptive. Using data from the National Health Interview Surveys from 2009 to 2015, this study examines changes in health insurance status and its determinants before the ACA in 2009, during its partial implementation in 2010–2013, and after its full implementation in 2014 and 2015. The results of trend analysis indicate a significant increase in national health insurance rate from 82.2% in 2009 to 89.4% in 2015. Logistic regression analyses confirm the similar impact of age, gender, race, marital status, nativity, citizenship, education, and poverty on health insurance status before and after the ACA. Despite similar effects across years, controlling for other variables, youth aged 26 or below, the foreign-born, Asians, and other races had a greater probability of gaining health insurance after the ACA than before the ACA; however, the odds of obtaining health insurance for Hispanics and the impoverished rose slightly during the partial implementation of the ACA but somewhat declined after the full implementation of the ACA starting in 2014. These findings should be taken into account by the U.S. government in deciding the fate of the ACA.


health insurance coverage; determinants; the Affordable Care Act; Obamacare; partial implementation; full implementation


Public Health and Healthcare, Health Policy and Services

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