{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T15:20:52Z","timestamp":1787671252006,"version":"build-2736575974"},"reference-count":41,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T00:00:00Z","timestamp":1774569600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T00:00:00Z","timestamp":1778112000000},"content-version":"vor","delay-in-days":41,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Health Serv Res"],"DOI":"10.1186\/s12913-026-14376-7","type":"journal-article","created":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T14:35:50Z","timestamp":1774622150000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Shifting barriers to health care access: from affordability to coverage issues"],"prefix":"10.1186","volume":"26","author":[{"given":"Riley","family":"League","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Mahmoudi Meymand","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,27]]},"reference":[{"issue":"4","key":"14376_CR1","doi-asserted-by":"publisher","first-page":"366","DOI":"10.1001\/jama.2015.8421","volume":"314","author":"BD Sommers","year":"2015","unstructured":"Sommers BD, Gunja MZ, Finegold K, Musco T. Changes in self-reported insurance coverage, access to care, and health under the Affordable Care Act. JAMA. 2015;314(4):366\u201374.","journal-title":"JAMA"},{"key":"14376_CR2","unstructured":"Collins SR, Bhupal HK, Doty MM. Health insurance coverage eight years after the ACA: Fewer uninsured Americans and shorter coverage gaps, but more underinsured. Commonw Fund. 2019;7."},{"issue":"3","key":"14376_CR3","doi-asserted-by":"publisher","first-page":"379","DOI":"10.1377\/hlthaff.2019.01448","volume":"39","author":"SA Glied","year":"2020","unstructured":"Glied SA, Collins SR, Lin S. Did The ACA Lower Americans\u2019 Financial Barriers To Health Care? A review of evidence to determine whether the Affordable Care Act was effective in lowering cost barriers to health insurance coverage and health care. Health Aff. 2020;39(3):379\u201386.","journal-title":"Health Aff"},{"key":"14376_CR4","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1016\/j.jhealeco.2017.02.004","volume":"53","author":"M Frean","year":"2017","unstructured":"Frean M, Gruber J, Sommers BD. Premium subsidies, the mandate, and Medicaid expansion: Coverage effects of the Affordable Care Act. J Health Econ. 2017;53:72\u201386.","journal-title":"J Health Econ"},{"issue":"4","key":"14376_CR5","doi-asserted-by":"publisher","first-page":"1028","DOI":"10.1002\/pam.22158","volume":"38","author":"J Gruber","year":"2019","unstructured":"Gruber J, Sommers BD. The Affordable Care Act\u2019s effects on patients, providers, and the economy: what we\u2019ve learned so far. J Policy Anal Manag. 2019;38(4):1028\u201352.","journal-title":"J Policy Anal Manag"},{"issue":"1","key":"14376_CR6","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1377\/hlthaff.2015.0755","volume":"35","author":"A Shartzer","year":"2016","unstructured":"Shartzer A, Long SK, Anderson N. Access to care and affordability have improved following Affordable Care Act implementation; problems remain. Health Aff. 2016;35(1):161\u20138.","journal-title":"Health Aff"},{"key":"14376_CR7","doi-asserted-by":"publisher","first-page":"004695801879636","DOI":"10.1177\/0046958018796361","volume":"55","author":"C Courtemanche","year":"2018","unstructured":"Courtemanche C, Marton J, Ukert B, Yelowitz A, Zapata D. Effects of the Affordable Care Act on health care access and self-assessed health after 3 years. INQUIRY: J Health Care Organ Provis Financing. 2018;55:0046958018796361.","journal-title":"INQUIRY: J Health Care Organ Provis Financing"},{"issue":"3","key":"14376_CR8","doi-asserted-by":"publisher","first-page":"496","DOI":"10.1377\/hlthaff.2020.01106","volume":"40","author":"C Liu","year":"2021","unstructured":"Liu C, Gotanda H, Khullar D, Rice T, Tsugawa Y. The Affordable Care Act\u2019s Insurance Marketplace Subsidies Were Associated With Reduced Financial Burden For US Adults: Study examines the ACA\u2019s insurance marketplace subsidies and financial burden on US adults. Health Aff. 2021;40(3):496\u2013504.","journal-title":"Health Aff"},{"issue":"9","key":"14376_CR9","doi-asserted-by":"publisher","first-page":"762","DOI":"10.1097\/MLR.0000000000001586","volume":"59","author":"J Chu","year":"2021","unstructured":"Chu J, Ortega AN, Park S, Vargas-Bustamante A, Roby DH. The Affordable Care Act and health care access and utilization among White, Asian, and Latino immigrants in California. Med Care. 2021;59(9):762\u20137.","journal-title":"Med Care"},{"key":"14376_CR10","doi-asserted-by":"publisher","unstructured":"Kominski GF, Narissa J, Nonzee, Sorensen A. The Affordable Care Act\u2019s Impacts on Access to Insurance and Health Care for Low-Income Populations. Annual Review of Public Health. (2017);38: 489\u2013505. https:\/\/doi.org\/10.1146\/annurev-publhealth-031816-044555. PMCID: PMC5886019.","DOI":"10.1146\/annurev-publhealth-031816-044555"},{"key":"14376_CR11","doi-asserted-by":"crossref","unstructured":"Schlesinger M, Bhaumik D. The Shadow Price of Uncertainty: Consequences of Unpredictable Insurance Coverage for Access, Care, and Financial Security. Milbank Q. 2025 Apr 28.","DOI":"10.1111\/1468-0009.70006"},{"issue":"5","key":"14376_CR12","doi-asserted-by":"publisher","first-page":"755","DOI":"10.1111\/1475-6773.13861","volume":"56","author":"MA Kyle","year":"2021","unstructured":"Kyle MA, Frakt AB. Patient administrative burden in the US health care system. Health Serv Res. 2021;56(5):755\u201365.","journal-title":"Health Serv Res"},{"key":"14376_CR13","unstructured":"Agency for Healthcare Research and Quality. 2023 National Healthcare Quality and Disparities Report (AHRQ Pub. No. 23(24)-0091-EF). Rockville, MD: U.S. Department of Health and Human Services. 2023."},{"key":"14376_CR14","doi-asserted-by":"publisher","first-page":"1549","DOI":"10.1186\/s12913-024-11921-0","volume":"24","author":"R Schuldt","year":"2024","unstructured":"Schuldt R, Jinnett K. Barriers accessing specialty care in the United States: A patient perspective. BMC Health Serv Res. 2024;24:1549.","journal-title":"BMC Health Serv Res"},{"key":"14376_CR15","doi-asserted-by":"crossref","unstructured":"Morenz AM, Liao JM, Au DH, Hayes SA. Area-level socioeconomic disadvantage and health care spending: A systematic review. JAMA Netw Open. 2024;7(2):e2356121.","DOI":"10.1001\/jamanetworkopen.2023.56121"},{"key":"14376_CR16","doi-asserted-by":"crossref","unstructured":"Acemoglu D, Finkelstein A, Notowidigdo M. Income and health spending: evidence from oil price Shocks. Review of Economics and Statistics. October 2013;95: 1079\u201395. 4.","DOI":"10.1162\/REST_a_00306"},{"key":"14376_CR17","doi-asserted-by":"publisher","first-page":"102898","DOI":"10.1016\/j.jhealeco.2024.102898","volume":"96","author":"S Strobel","year":"2024","unstructured":"Strobel S. Who responds to longer wait times? The effects of predicted emergency wait times on the health and volume of patients who present for care. J Health Econ. 2024;96:102898.","journal-title":"J Health Econ"},{"key":"14376_CR18","doi-asserted-by":"publisher","first-page":"976","DOI":"10.1007\/s10900-013-9681-1","volume":"38","author":"ST Syed","year":"2013","unstructured":"Syed ST, Gerber BS, Sharp LK. Traveling Towards Disease: Transportation Barriers to Health Care Access. J Community Health. 2013;38:976\u201393. https:\/\/doi.org\/10.1007\/s10900-013-9681-1.","journal-title":"J Community Health"},{"key":"14376_CR19","doi-asserted-by":"crossref","unstructured":"Brot-Goldberg ZC, Burn S, Layton T, Vabson B. Rationing medicine through bureaucracy: authorization restrictions in medicare. National Bureau of Economic Research; 2023. Jan 23.","DOI":"10.3386\/w30878"},{"issue":"5","key":"14376_CR20","doi-asserted-by":"publisher","first-page":"000","DOI":"10.1086\/734134","volume":"133","author":"P Eliason","year":"2025","unstructured":"Eliason P, League R, Leder-Luis J, McDevitt RC, Roberts JW. Ambulance Taxis: The Impact of Regulation and Litigation on Health-Care Fraud. J Polit Econ. 2025;133(5):000.","journal-title":"J Polit Econ"},{"key":"14376_CR21","doi-asserted-by":"crossref","unstructured":"Arbogast I, Chorniy A, Currie J. Administrative burdens and child Medicaid and CHIP enrollments (NBER Working Paper No. 30580). National Bureau of Economic Research. 2022.","DOI":"10.3386\/w30580"},{"issue":"4","key":"14376_CR22","first-page":"213","volume":"11","author":"M Deshpande","year":"2019","unstructured":"Deshpande M, Li Y. Who is screened out? Application costs and the targeting of disability programs. Am Economic Journal: Economic Policy. 2019;11(4):213\u201348.","journal-title":"Am Economic Journal: Economic Policy"},{"issue":"4","key":"14376_CR23","first-page":"271","volume":"13","author":"T Homonoff","year":"2021","unstructured":"Homonoff T, Somerville J. Program recertification costs: Evidence from SNAP. Am Economic Journal: Economic Policy. 2021;13(4):271\u201398.","journal-title":"Am Economic Journal: Economic Policy"},{"issue":"8","key":"14376_CR24","doi-asserted-by":"publisher","first-page":"1252","DOI":"10.1377\/hlthaff.2018.0179","volume":"37","author":"D Polsky","year":"2018","unstructured":"Polsky D, Candon MK, Chatterjee P, Chen X. Scope of primary care physicians\u2019 participation in the health insurance marketplaces. Health Aff. 2018;37(8):1252\u20136.","journal-title":"Health Aff"},{"issue":"9","key":"14376_CR25","doi-asserted-by":"publisher","first-page":"1606","DOI":"10.1377\/hlthaff.2016.1669","volume":"36","author":"LS Dafny","year":"2017","unstructured":"Dafny LS, Hendel I, Marone V, Ody C. Narrow networks on the health insurance marketplaces: prevalence, pricing, and the cost of network breadth. Health Aff. 2017;36(9):1606\u201314.","journal-title":"Health Aff"},{"key":"14376_CR26","unstructured":"Dieguez G, Mirchandani H. Evolution of the Use of Restrictions in Commercial Formularies. Milliman. 2019. Available from: https:\/\/www.milliman.com\/en-GB\/insight\/evolution-of-the-use-of-restrictions-in-commercial-formularies"},{"key":"14376_CR27","unstructured":"Jacobson G, Rae M, Neuman T, Orgera K, Boccuti C. Medicare Advantage: How Robust Are Plans\u2019 Physician Networks? Kaiser Family Foundation. 2017 5 Oct. Available from: https:\/\/www.kff.org\/medicare\/report\/medicare-advantage-how-robust-are-plans-physician-networks\/"},{"key":"14376_CR28","unstructured":"Jacobson G, Trilling A, Neuman T, Damico A, Gold M. Medicare Advantage Hospital Networks: How Much Do They Vary? Kaiser Family Foundation. 2016 20 June. Available from: https:\/\/www.kff.org\/medicare\/report\/medicare-advantage-hospital-networks-how-much-do-they-vary\/"},{"key":"14376_CR29","doi-asserted-by":"publisher","first-page":"102830","DOI":"10.1016\/j.jhealeco.2023.102830","volume":"93","author":"O Sarig","year":"2024","unstructured":"Sarig O. Pharmaceutical demand response to utilization management. J Health Econ. 2024;93:102830.","journal-title":"J Health Econ"},{"key":"14376_CR30","unstructured":"Jacobson G, Neuman T. Prior Authorization in Medicare Advantage Plans: How Often Is It Used? Kaiser Family Foundation. 2018 24 Oct. Available from: https:\/\/www.kff.org\/medicare\/issue-brief\/prior-authorization-in-medicare-advantage-plans-how-often-is-it-used\/"},{"key":"14376_CR31","doi-asserted-by":"crossref","unstructured":"Schwartz AL, Brennan TA, Verbrugge DJ, Newhouse JP. Measuring the scope of prior authorization policies: applying private insurer rules to Medicare Part B. JAMA Health Forum. 2021 6 May;2(5):e210859-e210859). American Medical Association.","DOI":"10.1001\/jamahealthforum.2021.0859"},{"issue":"1","key":"14376_CR32","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1377\/hlthaff.2021.01054","volume":"41","author":"AL Schwartz","year":"2022","unstructured":"Schwartz AL, Chen Y, Jagmin CL, Verbrugge DJ, Brennan TA, Groeneveld PW, Newhouse JP. Coverage Denials: Government And Private Insurer Policies For Medical Necessity In Medicare: Study examines medical necessity coverage denials in Medicare and private insurers. Health Aff. 2022;41(1):120\u20138.","journal-title":"Health Aff"},{"issue":"1","key":"14376_CR33","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1093\/qje\/qjad035","volume":"139","author":"A Dunn","year":"2024","unstructured":"Dunn A, Gottlieb JD, Shapiro AH, Sonnenstuhl DJ, Tebaldi P. A denial a day keeps the doctor away. Q J Econ. 2024;139(1):187\u2013233.","journal-title":"Q J Econ"},{"key":"14376_CR34","unstructured":"League R. Administrative burden and consolidation in health care: Evidence from Medicare contractor transitions. Working Paper. 2023 Sep. Available from: https:\/\/rileyleague.github.io\/files\/MAC_transitions.pdf."},{"key":"14376_CR35","unstructured":"Kaiser Family Foundation. Employer Health Benefits Survey (Sect.\u00a08: High-Deductible Health Plans with Savings Option). Kaiser Family Foundation. Published. 2024 9 Oct."},{"key":"14376_CR36","unstructured":"Centers for Medicare & Medicaid Services (CMS). Shared Savings Program Fast Facts: 2024. Centers for Medicare & Medicaid Services; 2024."},{"issue":"9","key":"14376_CR37","doi-asserted-by":"publisher","first-page":"1530","DOI":"10.1377\/hlthaff.2017.0556","volume":"36","author":"BD Fulton","year":"2017","unstructured":"Fulton BD. Health Care Market Concentration Trends in the United States: Evidence and Policy Responses. Health Aff. 2017;36(9):1530\u20138.","journal-title":"Health Aff"},{"key":"14376_CR38","unstructured":"Freed M, Biniek JF, Damico A, Neuman T. Medicare Advantage in 2024: Enrollment Update and Key Trends. Volume 8. Kaiser Family Foundation; 2024."},{"issue":"6","key":"14376_CR39","doi-asserted-by":"publisher","first-page":"e231744","DOI":"10.1001\/jamahealthforum.2023.1744","volume":"4","author":"AL Schwartz","year":"2023","unstructured":"Schwartz AL, Kim S, Navathe AS, Gupta A. Growth of Medicare Advantage After Plan Payment Reductions. JAMA Health Forum. 2023;4(6):e231744.","journal-title":"JAMA Health Forum"},{"issue":"3","key":"14376_CR40","doi-asserted-by":"publisher","first-page":"1261","DOI":"10.1093\/qje\/qjx013","volume":"132","author":"ZC Brot-Goldberg","year":"2017","unstructured":"Brot-Goldberg ZC, Chandra A, Handel BR, Kolstad JT. What does a deductible do? The impact of cost-sharing on health care prices, quantities, and spending dynamics. Q J Econ. 2017;132(3):1261\u2013318.","journal-title":"Q J Econ"},{"issue":"4","key":"14376_CR41","doi-asserted-by":"publisher","first-page":"1623","DOI":"10.1093\/qje\/qjv029","volume":"130","author":"K Baicker","year":"2015","unstructured":"Baicker K, Mullainathan S, Schwartzstein J. Behavioral hazard in health insurance. Q J Econ. 2015;130(4):1623\u201367.","journal-title":"Q J Econ"}],"container-title":["BMC Health Services Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12913-026-14376-7","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12913-026-14376-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12913-026-14376-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T12:05:10Z","timestamp":1778155510000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12913-026-14376-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,27]]},"references-count":41,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["14376"],"URL":"https:\/\/doi.org\/10.1186\/s12913-026-14376-7","relation":{},"ISSN":["1472-6963"],"issn-type":[{"value":"1472-6963","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,27]]},"assertion":[{"value":"15 October 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 March 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 March 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The research is compliant with the Helsinki Declaration.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Human ethics and consent to participate"}},{"value":"The University of Illinois IRB determined this study did not constitute human subjects research.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"IRB approval"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"647"}}