Health Policy$ense

The Doctor Will See You Now: Appointment Availability for Medicaid Patients

Post-ACA boost detected

House Speaker Ryan recently claimed that “[t]he problem that we’re seeing in Medicaid is more and more doctors just won’t take Medicaid, because they lose money on Medicaid.” Our new paper in JAMA Internal Medicine, “Changes in Primary Care Between 2012 and 2016 for New Patients with Medicaid and Private Coverage,” suggests otherwise. We find that more Medicaid patients were able to schedule appointments with a doctor, at least in primary care, after the Affordable Care Act’s (ACA) implementation than before. Given the millions of newly-insured Americans looking to secure primary care appointments, these results are an unexpected and welcome addition to the ongoing debate on health reform.

In the wake of the ACA’s optional extension of Medicaid eligibility to low-income, nonelderly, and childless adults, some policymakers have raised concerns that capacity constraints would limit new Medicaid enrollees’ ability to translate coverage into care. To measure access for Medicaid patients, we conducted a unique audit study of primary care practices before and after the ACA. Scripted staff posed as new patients with Medicaid or private coverage and called thousands of primary care practices across ten states. Callers measured the appointment availability rate and, for those who were able to schedule an appointment, the number of days to appointment.

When House Speaker Ryan stated that 'people on Medicaid can’t get a doctor, and if you can’t get a doctor, what good is your coverage?' he underestimated the ability of providers to accommodate the influx of newly-insured Americans.

Surprisingly, we found that primary care appointment availability for Medicaid patients increased from 57.9 percent to 63.2 percent between 2012/13 and 2016 in ten study states. There was no significant change in appointment availability for the privately insured. While the gap in appointment availability between Medicaid and private coverage remains, it fell from nearly 27 percentage points in 2012/3 to 20 percentage points in 2016. Over the same period, patients with both insurance types experienced a one-day increase in median wait times, which may explain the increasing appointment availability results.

Investments in primary care, such as the ACA’s allocation of funding to federally qualified health centers, may have improved primary care’s ability to accommodate increases in demand. Medicaid becoming a larger portion of the pool of insured individuals could also encourage providers to accept new Medicaid patients – we explore this possibility in our recent LDI Issue Brief and find that the increases in appointment availability between 2012/3 and 2016 were concentrated in those states that opted into the Medicaid expansion and experienced the largest gains in Medicaid enrollment.

When House Speaker Ryan stated that “people on Medicaid can’t get a doctor, and if you can’t get a doctor, what good is your coverage?” he underestimated the ability of providers to accommodate the influx of newly-insured Americans. Our new paper and accompanying brief show that 1) primary care appointment availability has increased for Medicaid patients since the ACA’s implementation, 2) increased access for Medicaid patients has not affected appointment availability for the privately insured, and 3) the gap in access between Medicaid and private coverage is narrowing, a promising trend.

As policymakers from across the political spectrum attempt to improve our uniquely American health care system, there is an urgent need for facts rather than fairy tales. Moving forward, LDI will continue its rigorous examination of the ACA, with a special focus on how its provisions are affecting patient care. We will soon make these unique audit data publicly available, offering researchers the detailed information on primary care practices and patient access by insurance type.