Despite predictions of severe primary care shortages due to increased health coverage under the ACA, a study published in JAMA Internal Medicine shows primary care appointment availability increased for Medicaid patients after the implementation of the ACA — without reducing availability for privately insured patients.
The study involved simulated patients calling in-network PCP offices to request a new patient appointment in 10 states: Arkansas, Georgia, Illinois, Iowa, Massachusetts, Montana, New Jersey, Oregon, Pennsylvania and Texas. The "secret shoppers" called practices in 2012-2013 and again in 2016 to compare changes in appointment availability and wait time. By 2016, all but two states in the study — Georgia and Texas — had expanded Medicaid.
The findings were counterintuitive — although numbers of insured patients increased over the time period studied, on the whole, so did appointment availability for Medicaid patients. Across the 10 states studied, PCP appointment availability increased 5.4 percentage points for new Medicaid patients, while availability remained steady for privately insured patients. The most substantial gains were found in Medicaid expansion states. Researchers found a 20 percentage point increase in appointment availability for Medicaid patients in Illinois, an 8.1 percentage point increase in Iowa and a 7.2 percentage point increase in Pennsylvania. Privately insured patients in Oregon and Arkansas did experience a decrease in appointment availability.
The authors suggest practices were able to absorb the new patients through a combination of strategies, which may include shorter visits, team-based practices, retail clinics and longer wait times. The study did show the downside to the increased patient panel size was the increase in long wait times. Researchers found short wait times, defined as less than a week, decreased among Medicaid patients by 6.7 percentage points and among privately insured patients by 4.1 percentage points. Meanwhile, long wait times, defined as 30 days or more, increased among privately insured patients by 3.3 percentage points.
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