Rise in Insured Americans Did Not Hurt Access to Care

The boost in the number of newly insured Americans as a result of the ACA did not hamper access to care for Americans who already had health insurance, according to a study in Health Affairs.

“Despite concerns, increasing rates of insurance coverage did not appear to reduce access to care among the continuously insured,” Salam Abdus, PhD, and Steven C Hill, PhD, of the Agency for Healthcare Research and Quality, wrote.

The researchers examined data from the Medical Expenditure Panel Survey for the years 2008 through 2014. The study focused on eight measures of access: whether the adult had a usual source of care other than the emergency department, was unable to receive necessary medical care, experienced delays in receiving necessary medical care, had a routine checkup in the past year, had a blood pressure screening in the past year, had a flu shot in the past year, experienced delays in getting doctor appointments, and had a problem seeing a specialist.

Across all eight measures, the analysis provided no consistent evidence that access to care for continuously insured adults was impacted by increases to newly insured residents in the same geographic area. 

“This remained true even when we restricted our sample to adults residing in geographic Health Professional Shortage Areas or to adults continuously insured by Medicaid,” the researchers added.

Funding under the ACA to improve provider capacity may have played a role in avoiding access issues, researchers theorized. Community health center expansions and added sites of care likely helped handle increases in health care demand. Other ACA funding that supported health care provider training may have helped grow the population of nurse practitioners.

The growth in patient-centered medical homes and shifts away from fee-for-service may have also helped practices become more efficient in delivering care. 

“States may find the results in this analysis useful for making policy decisions,” they wrote, “such as whether to expand Medicaid and whether to expend their own resources to increase enrollment in private nongroup insurance or HSAs.”—Jolynn Tumolo