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BACKGROUND Health care access increased for low-income Americans under the Affordable Care Act (ACA). It is unknown whether these changes in access were associated with improved self-reported health. OBJECTIVE Determine changes in health care access, health behaviors, and self-reported health among low-income Americans over the first 4 years of the ACA, stratified by state Medicaid expansion status. DESIGN Interrupted time series and difference-in-differences analysis. SUBJECTS Noninstitutionalized US adults (18-64 y) in low income hous