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ACA does not worsen primary care shortage for Medicaid, private coverage patients

Appointment availability increased for new Medicaid patients and remained stable for privately insured patients between 2012 and 2016, suggesting that the Affordable Care Act did not worsen the primary care shortage, according to a research letter.

“Anticipating heightened demand, policymakers launched concurrent initiatives to strengthen primary care delivery, such as raising Medicaid reimbursement to Medicare levels for certain primary care providers in 2013 and 2014, increasing funds for federally qualified health centers and expanding the penetration of Medicaid managed care,” Daniel Polsky, PhD, from the department of health care management and the division of general internal medicine at the University of Pennsylvania, and the Leonard Davis Institute of Health Economics, and colleagues wrote.

In this audit study, researchers asked simulated patients randomized to an insurance type (Medicaid or private coverage) and clinical scenario (hypertension or check-up) to request new patient appointments from primary care practices in 10 geographically diverse U.S. states. They assessed changes in appointment availability and the probability of short wait times (1 week or less) and long wait times (more than 30 days) from Nov. 13, 2012 to April 3, 2013, and from Feb. 8, 2016 to June 16, 2016. Using 2-tailed tests, weights and county-clustered standard errors, they tested for significant differences in means.

The results showed appointment availability increased 5.4 percentage points (95% CI, 2.1-8.6) and short wait times decreased 6.7 percentage points (95% CI, –10.1 to –3.3) for Medicaid callers across the 10 states between 2012-2013 and 2016. Polsky and colleagues observed no significant change in appointment availability for privately insured callers; however, short wait times decreased 4.1 percentage points (95% CI, –6.3 to –1.9) and long wait times increased 3.3 percentage points (95% CI, 1.9-4.8). Appointment availability under Medicaid still trailed private coverage in 2016, but the gap between insurance types narrowed.

Medicaid callers saw increasing appointment availability in Illinois, Iowa and Pennsylvania. Comparatively, privately insured callers saw increasing appointment availability only in Pennsylvania, but decreases in Oregon and Arkansas. In the remaining states — Georgia, Massachusetts, Montana New Jersey and Texas — researchers saw no significant change in appointment availability for either insurance type.

“The increase in appointment availability is particularly surprising given the expiration of the Medicaid rate increase in most states,” Polsky and colleagues wrote. “The absorption of patients can explain the longer wait times, which was similarly observed in Massachusetts after it expanded Medicaid in 2006.”

Previous research has found that Medicaid expansion under the Affordable Care Act improved health and financial stability with the HHS reporting in 2016 that 93% of new Medicaid enrollees were satisfied with their health care plans, and 92% were satisfied with their doctors. In addition, another 2016 study showed Kentucky’s Medicaid program and Arkansas’ private option resulted in significant improvements in health care quality during their second year of expansion, as well as increases in preventive care, outpatient utilization and self-reported health. However, more recent survey from NORC at the University of Chicago revealed that although important pieces of the health care law are effective and popular, many Americans strongly support changes, but not an immediate repeal, to the ACA. – by Savannah Demko

Disclosure: Polsky reports no relevant financial disclosures.