Access to Primary Care Appointments Following 2014 Insurance Expansions

Abstract

Contrary to widespread concern, we find no evidence that the millions of individuals newly insured through the ACA decreased new-patient appointment availability across 10 states as shown by stable wait times and appointment rates for private insurance as of mid-2014.

Primary Care Access to New Patient Appointments for California Medicaid Enrollees: A Simulated Patient Study

“…Factors contributing to this variability include county-level Medi-Cal population differences, relative shortages of PCCs accepting new Medi-Cal patients, and number of FQHCs, as well as countylevel structural and organizational factors related to Medi-Cal managed care plans. Although prior work from other states has suggested that increased reimbursement to Medicaid clinicians may improve appointment availability, 10,11,21 our finding of variation across counties in the same state confirms that other factors are also important.…”

“…A similar study adding FQHCs to the sampled practices in the same 10 states found comparable results. 21 These analyses did not account for variation by state in the number of new enrollees needing an appointment with a PCC. Our simulated experience of locating primary care for individuals and families with Medi-Cal coverage is consistent with the typology of DeVoe et al 5 suggesting that access to care is a critical priority.…”

In This Issue: On-the-Ground Advances & High-Level Influences

“…In 10 diverse states, by the measure of median wait times for new appointments, there was no evidence of being overwhelmed. 12 …”

Access to Primary, Mental Health, and Specialty Care: a Comparison of Medicaid and Commercially Insured Populations in Oregon

“…This sentiment was expressed by Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma, who noted that Medicaid would fail to live up to its promise if it Bmerely provides a card without care.^3 These concerns are not unwarranted; simulated patient studies have concluded that commercially insured patients' ability to secure appointments in primary care settings is about 25 percentage points higher than Medicaid patients', 4,5 with access for Medicaid patients improving slightly following the ACA's 2014 Medicaid expansion. 6,7 Empirical evidence about access to care can help inform debate about the relative value of the Medicaid program. Studies of differences in access to primary care have not been consistent, [8][9][10][11][12] and less is known about variability in access across urban or rural areas, 13,14 particularly when it comes to accessing mental health care (an important service for Medicaid enrollees), or other types of specialty care.…”