New patients enrolled in Medicaid and private health plans generally are able to get timely appointments for primary care, despite an increase in the number of U.S. residents who have coverage because of the Affordable Care Act (ACA), according to a research letter published in JAMA Internal Medicine, Michelle Andrews reports for Kaiser Health News.
The research aimed "to assess the [ACA's] effect on primary care access." To do so, field workers posed as individuals newly enrolled in Medicaid or private health plans and called physician practices in 10 states requesting a new-patient appointment for either a checkup or newly diagnosed hypertension. The callers requested the earliest appointments available and reported whether they were able to schedule an appointment and, if so, the amount of time between their calls and the date for which the appointments were scheduled.
The field workers first called more than 9,700 practices between Nov. 13, 2012, and April 3, 2013, before most states expanded Medicaid under the ACA. The field workers then made a second round of calls to 7,300 practices between Feb. 8, 2016, and June 16, 2016. The practices called during both rounds were located across expansion and non-expansion states.
The researchers then compared the results of the first and second rounds of calls to assess any changes in appointment availability and wait times.
Between the first and second round of calls, appointment availability increased by 5.4 percentage points for simulated Medicaid beneficiaries and remained stable for individuals who claimed to be enrolled in private health plans.
However, the research found that both patient groups were less likely in their second round of calls to be able to schedule an appointment within one week's time. According to the research:
- 52.7 percent of privately insured callers could make an appointment within one week during the second round of calls, down by 4.1 percentage points from the first round; and
- 49.1 percent of Medicaid callers could make an appointment within one week during the second round of calls, down by 6.7 percentage points from the first round.
The researchers wrote that "the gap in appointment availability between insurance types narrowed" between the first round of calls and the second round, "but Medicaid rates still lagged behind private coverage in 2016."
The researchers said the findings should alleviate concerns that the ACA's coverage expansions worsened a primary care shortage in the United States.
However, Daniel Polsky, the research letter's lead author and executive director of the University of Pennsylvania's Leonard Davis Institute of Health Economics, said barriers to accessing care still exist and vary by region. "It's still true that fewer doctors are willing to see Medicaid patients than are willing to see commercial patients," Polsky said, adding, "But if you have Medicaid, your access to doctors is still good" (Andrews, Kaiser Health News, 3/3; Polsky, JAMA Internal Medicine, 2/27).
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