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ACA did not impact primary care access

The primary care health system absorbed the influx of new patients caused by the Affordable Care Act, according to research recently published in Annals of Family Medicine.

The findings are the latest to refute the claims, mostly made by Republicans, that the Affordable Care Act (ACA) restricted access to health care. Other research, including a recent study in The New England Journal of Medicine, also found that ACA did not hinder patient access.

“Despite widespread concerns that the influx of millions of individuals newly insured through Medicaid and the marketplaces would strain the primary care system, we find no evidence of such a phenomenon as of mid-2014, as evidenced by the stability in appointment rates and wait times for new privately insured patients and an increase in appointment access for new Medicaid patients in our 10 study states,” Karin V. Rhodes, MD, MS, vice president, care management design and evaluation, Office of Population Health, Northwell Health, Great Neck, New York, and colleagues wrote.

Rhodes and colleagues had simulated patients with private insurance or Medicaid make 9,737 phone calls (private insurance n = 5,385) in 2012 and 2013 and another 4,898 calls in 2014 (private insurance n = 2,424). These “pretend” patients were told to schedule either the earliest available appointment for a routine appointment or an urgent care visit for a newly diagnosed, untreated hypertension condition with a specific physician. If this medical professional was not available for more than 4 weeks in the routine scenario, or 2 weeks in the urgent care scenario, the simulated patient went with the first available provider within the same practice. Calls were made in Arkansas, Georgia, Iowa, Illinois, Massachusetts, Montana, New Jersey, Oregon, Pennsylvania, and Texas. Researchers stated they chose these states for their health system and geographic diversity.

Researchers wrote that overall, Medicaid appointment rates increased 9.7 percentage points (57.9% to 67.6%) with substantial variation by state. Across all callers, median wait times for those obtaining an appointment were 7 days in 2012 and 5 days in 2014, but the difference was not statistically significant.

Overall appointment rates for private insurance remained stable during the study period (84.7%-85.8%). Across all states, median wait times in calendar days for privately insured callers obtaining an appointment were 6 days both in 2012-2013 and in 2014 while median wait times for Medicaid were 6 days in 2012-2013 and 7 days in 2014.

Rhodes and colleagues acknowledged other possible reasons, both positive and negative, for their results, including performing the study too soon after ACA’s implementation to gauge its full effect, choosing practices that had sufficient capacity to handle the influx, primary care practices restructuring operations to provide care and medical professionals communicating with patients through phone calls and emails rather than asking all patients to come in for an appointment.

“A less rosy view is that providers may simply be seeing more patients in a given day. If this is the case, the added patient load may be contributing to the increasing primary care physician dissatisfaction and burnout that has been widely discussed and that may portend an unsustainable future for primary care,” Rhodes and colleagues wrote. “In addition, it is possible that the increase in demand for care from the insurance expansions may have been offset to some extent by decreases in demand following the recession. If so, when demand picks up across the economy, we may see more pressure on supply.” – by Janel Miller

Disclosure: The researchers report no relevant financial disclosures.