Official websites use. Share sensitive information only on official, secure websites. Correspondence and requests for reprints should be addressed to Sarah M. Lyon, M. E-mail: Sarah. The Affordable Care Act was intended to address systematic health inequalities for millions of Americans who lacked health insurance. Expansion of Medicaid was a key component of the legislation, as it was expected to provide coverage to low-income individuals, a population at greater risk for disparities in access to the health care system and in health outcomes.
Several studies suggest that expansion of Medicaid can reduce insurance-related disparities, creating optimism surrounding the potential impact of the Affordable Care Act on the health of the poor. Moreover, relative to many private plans, Medicaid is an imperfect program suffering from lower reimbursement rates, fewer covered services, and incomplete acceptance by preventive and specialty care providers.
These constraints will reduce the potential impact of the expansion for patients with respiratory and sleep conditions or critical illness. Despite its imperfections, the more than 10 million low-income individuals who gain insurance as a result of Medicaid expansion will likely have increased access to health care, reduced out-of-pocket health care spending, and ultimately improvements in their overall health.
Access to affordable and high-quality health care varies widely in the United States. Pervasive inequalities exist across multiple domains, including geographic regions, sex, racial and ethnic groups, and socioeconomic status.
An important contributor to such inequalities is variability in health insurance coverage. In the absence of universal health care coverage or insurance, more than 47 million nonelderly Americans were without health insurance in 1. Lack of insurance is a particularly important contributor to poor outcomes among patients who have pulmonary disease or those who develop critical illness. For example, relative to the insured, individuals who lack health insurance have a greater incidence of lung cancer, are often diagnosed at a later stage of disease, and experience worse survival 2.
