Electronic Theses and Dissertations



Document Type


Degree Name

Doctor of Philosophy


Public Health

Committee Chair

Vikki Nolan

Committee Member

Meredith Ray

Committee Member

Courtnee Melton-Fant

Committee Member

Fawaz Mzayek


A primary goal of the Affordable Care Act (ACA) was to increase health insurance coverage, reduce health care costs, and improve quality of care. Insurance coverage expanded, however, the effect of the ACA on barriers to accessing care and quality of care is less apparent. Outcome variables related to barriers (having a usual source of care, delaying care due to cost, forgoing care due to cost) and quality (whether healthcare providers always: showed respect, spent enough time listened, explained; and an overall rating of providers) from the Medical Expenditure Panel Survey (MEPS) were examined to evaluate whether barriers to healthcare and quality of care have changed since the implementation of the ACA. The analysis was performed on all adults who participated in MEPS aged 18-64 and on subgroups: young adults aged 18-25 due to the provision expanding coverage from their parents’ insurance; and adults aged 18-64 with a chronic condition and private insurance to assess secular background changes. In all groups, having a usual source of care decreased from 2009 to 2019 while delaying and forgoing care due to cost rose significantly. Quality of care showed differences across race; Whites reported no improvements or slight declines while all other races reported improvements. Results show that barriers to accessing care may have worsened from 2009 to 2019, however, some evidence suggests that the quality of care reported by minority racial groups have improved. It is unknow to what extent barriers to accessing care and quality of care impact health. Mental and physical self-reported health were examined as outcomes associated with barriers to accessing care and quality of care in all adults aged 18 and over who participated in the 2019 MEPS. Most of the sample reported good self-reported health, although the impact of barriers on self-reported health were largely negative, suggesting delaying or forgoing care due to cost is done at the expense of health. High quality of care was positively associated with good self-reported health in Whites. Results suggest that exposure to barriers to accessing care and a negative quality of care may have a negative impact on health.


Data is provided by the student.

Library Comment

Dissertation or thesis originally submitted to ProQuest


Open Access