In April 2008, the National Institutes of Health (NIH) implemented the Public Access Policy (PAP), which mandated that the full text of NIH-supported articles be made freely available on PubMed Central - the NIH's repository of biomedical research. This paper uses 600,000 NIH articles and a matched comparison sample to examine how the PAP impacted researcher access to the biomedical literature and publishing patterns in biomedicine. Though some estimates allow for large citation increases after the PAP, the most credible estimates suggest that the PAP had a relatively modest effect on citations, which is consistent with most researchers having widespread access to the biomedical literature prior to the PAP, leaving little room to increase access. I also find that NIH articles are more likely to be published in traditional subscription-based journals (as opposed to 'open access' journals) after the PAP. This indicates that any discrimination the PAP induced, by subscription-based journals against NIH articles, was offset by other factors - possibly the decisions of editors and submission behaviour of authors.