Research Brief
More Low-Income Adults Reported Having a Usual Source of Care After the Affordable Care Act
Background and Goal: Before the Affordable Care Act (ACA), uninsured and low-income adults were less likely to have a usual source of care due to cost, coverage, and access barriers. This study evaluated changes in the prevalence of usual sources of care and the reasons for lacking one before and after ACA implementation.
Study Approach: Researchers analyzed 2010 to 2017 data from the Medical Expenditure Panel Survey-Household Component (MEPS-HC), a nationally representative survey of the U.S. civilian, noninstitutionalized population. The study sample included 36,738 adults ages 18 to 64 and was divided into pre-ACA (2010-2013) and post-ACA (2014-2017) implementation. The primary outcome was self-reported usual source of care status and, if none existed, the main reason why.
Main Results:
The national usual source of care rose from 67% to 68% after the ACA, with the largest gains among low-income adults in both rural (+4.96 percentage points) and urban (+2.45 percentage points) areas. Reports by urban high-income adults declined slightly (-1.98 percentage points) while rural high-income adults showed no significant change.
After the ACA, reasons for lacking a usual source of care shifted in urban areas: affordability and insurance-related barriers decreased across income groups, accessibility increased across all income groups, and individual-preference reasons increased for low- and middle-income adults.
Why It Matters: The findings suggest that while low-income adults reported gains in usual sources of care, insurance expansion alone may not ensure consistent access to care, especially given persistent non-financial access challenges.
Permanent link: Usual Source of Care Among Adults Aged 18-64 Years Post-ACA, 2010-2017
Sara Shahbazi, PhD, MSPH
Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
The Annals of Family Medicine
22-Sep-2025