Health Reform Under the Patient Protection and Affordable Care Act: Characteristics of Exchange-Based Health Insurance Enrollees

Backgound and Purpose:    The Affordable Care Act (ACA) reformed and expanded healthcare coverage with an exchange-based health insurance program.   There are limited studies on the characteristics of health exchange enrollees.  The purpose of this study is to describe characteristics of exchange-based enrollees by comparing them to those who had no health insurance. Social workers will be better prepared to assist enrollees if there is as better understanding of who is participating in the exchanges, and to advocate for those who may not be able to be on the roles.

 Methods:  A retrospective, cross-sectional study using data from the 2014 National Health Interview (NHIS).  Exchange-based insurance utilization was identified with questions that were added by the NHIS to capture healthcare obtained through the health exchanges.  Chi-square tests were conducted to compare characteristics of health exchange enrollees with individuals who had no health insurance.  Logistic regression was used to examine factors associated with exchange-based insurance enrollees.

Results:  People with multiple chronic diseases, females, married people, and people with higher educational attainment were more likely to have exchange-based insurance.

 Conclusion and Implication: Although creating a large pool of low risk, healthier, younger people was the intent of many legislators who supported the ACA, to the contrary and not surprisingly, the insured population is largely higher risk individuals with greater healthcare needs.  Policies to repeal and replace ACA need to strengthen the health insurance exchange market to reduce the adverse health impact on these individuals.