This brief reviews the evidence on how key ACA provisions have affected the growth of health care costs. Coverage expansions produced a predictable jump in health care spending, amidst a slowdown that began a decade ago. Although we have not returned to the double-digit increases of the past, the authors find little evidence that ACA cost containment provisions produced changes necessary to “bend the cost curve.” Cost control will likely play a prominent role in the next round of health reform and will be critical to sustaining coverage gains in the long term.
In the current debate in Congress over the Affordable Care Act (ACA), the issue of provider access is a major concern.Our 10-state audit study published in JAMA Internal Medicine finds that primary care appointment availability for new patients with Medicaid increased 5.4 percentage points between 2012 and 2016 and remained stable for patients with private coverage. Over the same period, both Medicaid patients and the privately insured experienced a one-day increase in median wait times. Higher appointment availability for Medicaid patients is a surprising result given the increase in demand for care from millions of new Medicaid enrollees. In this Issue Brief, we summarize our study’s findings, expand on possible explanations, and extend the analysis by examining the relationship between appointment availability and state-level Medicaid expansions. We find that access to primary care increased for Medicaid patients only in states that extended Medicaid eligibility to low-income, nonelderly adults. Combined, these results suggest coverage provisions in the ACA have not overwhelmed primary care capacity.
In a review of the evidence, the authors find that the ACA had minimal effect on employment, hours of work, and compensation. This brief provides critical perspective on the effects of reforms on labor markets for federal and state policymakers as they consider changing or repealing the law.
Evidence on the effects of bundled payment is more important than ever, while hospitals already in Medicare bundled payment programs need guidance in redesigning care. This observational study looks at whether bundled payment for joint replacement affected quality, hospital costs and post-acute care spending in a health system that was an early adopter of the model. Did the bundles save money, and if so, what produced those savings?
This brief details changes in insurance coverage and access to care under the Affordable Care Act. About 20 million individuals gained coverage under the law and access to care improved. Despite these gains, more than 27 million individuals are still uninsured, and many others face barriers in accessing care. As a result of the 2016 elections, the future of the ACA is uncertain. As the next Administration and policymakers debate further health system reforms, they should consider the scope of the ACA’s effects on their constituents.
Effect of a Decision Aid on Access to Total Knee Replacement for Black Patients With Osteoarthritis of the Knee: A Randomized Clinical Trial
An educational video on the risks and benefits of total knee replacement increased the rate of surgery among black patients, in a clinical trial of an intervention that could reduce known racial disparities in treatment of osteoarthritis.
In this brief, we describe the breadth of physician provider networks offered on the health insurance marketplaces in 2016, and present differences by plan type, physician specialty, and state. We also compare networks in 2016 to those in 2014. We ﬁnd little change in overall prevalence of narrow networks, but we ﬁnd important geographic shifts and a trend towards x-small networks among plans with narrow networks. We discuss the policy implications of our ﬁndings for consumers, regulators, and health plans.
This issue brief is first in a four-part series that will summarize the latest evidence on how the Affordable Care Act has affected key areas of our health and economic systems. It explores the current volatility in the ACA’s Marketplaces and discusses key factors in their evolution over the past three years. The brief concludes with options for policymakers to address the turmoil in the Health Insurance Marketplaces.
Recurrent Violent Injury: Magnitude, Risk Factors and Opportunities For Intervention From a Statewide Analysis
Recurrent injury is a promising target for prevention, as prior injury is a strong predictor of future violent injury and death. But the incidence of recurrent violent injury, on an area-wide level, is unknown, and the risk factors contributing to it are not well understood.
Marketplace Plans With Narrow Physician Networks Feature Lower Monthly Premiums Than Plans With Larger Networks
Insurers offering plans on the Affordable Care Act’s health insurance marketplaces have used a strategy of restricted, or narrow, provider networks to limit costs. Narrow network plans are thought to be less expensive for consumers, but how much are they actually saving in premiums by choosing such plans? This study uses data from all ‘silver’ plans offered on the marketplaces in 2014 in all 50 states and the District of Columbia to categorize networks into “t-shirt sizes” and to estimate the association between the breadth of a provider network and plan premiums.
This issue brief discusses the role of primary care teams in identifying illicit drug use disorders in their patients, the continuum of treatments that they can offer, and opportunities for successful collaboration and integration with specialists. The authors find opportunities exist for increased patient screening and delivering medication-assisted treatment as well as established models for collaboration and integration of opioid treatments.
Physicians’ Participation In ACOs Is Lower In Places With Vulnerable Populations Than In More Affluent Communities
Early evidence suggests that accountable care organizations (ACOs) - networks of doctors and hospitals whose members share responsibility for providing coordinated care to patients - improve health care quality and constrain costs. ACOs are increasingly common in the U.S., both for Medicare and commercially insured patients. However, there are concerns that ACOs may worsen existing disparities in health care quality if disadvantaged patients have less access to physicians who participate in them. Does physicians’ ACO participation relate to the sociodemographic characteristics of their patient population, and if so, why?
Geographic access to primary care providers is usually considered a problem of rural areas, rather than of more densely populated urban ones. But the supply of primary care providers may be inadequate in certain neighborhoods even if the number of providers for the population is adequate for the city as a whole.The authors conducted a spatial analysis of census tracts in Philadelphia to assess the supply of primary care providers, quantify differences in supply that might contribute to disparities, and determine population characteristics associated with variations in geographic access. They calculated the ratio of adults-per-primary-care-provider in each tract using a five-minute travel time from the center of each census tract. They wanted to know if the overall number of providers in a city obscures significant differences across neighborhoods, and if so, whether low-access neighborhoods are more likely to be found in areas with large concentrations of racial and ethnic minorities.
Effects of Autism Spectrum Disorder Insurance Mandates on the Treated Prevalence of Autism Spectrum Disorder
State mandates requiring commercial health plans to cover services for children with autism spectrum disorder increased the number of children diagnosed with the disorder. However, diagnosis rates remain much lower than community estimates, suggesting that many commercially insured children with ASD remain undiagnosed or are insured through public plans.
Primary Care Appointment Availability for Medicaid Patients: Comparing Traditional and Premium Assistance Plans
In 2014, Arkansas and Iowa expanded their Medicaid programs and enrolled many of their adult beneficiaries in commercial Marketplace plans. This study suggests that this “private option” may make it easier for new Medicaid patients to get primary care appointments.