A new study finds the health care system and its providers were able to keep up with care for the continuously insured even as health insurance coverage expanded, increasing the pool of people who sought care, and points out states may find the study's conclusions useful in such policy decisions as whether to expand Medicaid.
Related: 2017 cost containment strategies
A study from the Health Affairs May issue has reached that conclusion, despite concerns expanded access to care through the Affordable Care Act would strain the resources of providers in caring for those who already had insurance.
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But, the study finds, data from the Medical Expenditure Panel Survey for 2008–2014 reveals no consistent evidence that increases in the proportions of adults with insurance at the local-area level affected access to care for adults residing in the same areas who already had, and continued to have, insurance.
Even people residing in health care professional shortage areas and Medicaid beneficiaries, two subpopulations that were seen as at greater risk of coming up short on care, did not suffer through the expanded access.
There had been concern that recent increases in the number of insured people could result in "negative spillovers" cutting the ability of people who were already insured to get care and obtain preventive services. In addition, it was thought that negative spillovers might be largest where there were the largest gains in the insured as a percentage of the local population.
While that was the case in Massachusetts in 2007, when the state expanded its own insurance and, as a result, physicians and patients there reported access problems that suggest negative spillovers resulting from the insurance expansion. The report says that, after the expansion, physician surveys indicated reduced physician participation in Medicaid and increased waiting times.
Although access to care generally improved in the state, some people had trouble finding providers that accepted their insurance, and some reported using emergency rooms for nonemergency conditions.
The study took into account the three factors govern whether there will be a negative spillover in the event of an expansion: the willingness and capacity of providers to provide more visits and supply additional services; how the provider market is segmented as regards insurance; and the effects of ACA provisions intended to increase health care capacity.
Researchers conclude, however, based on the data reviewed, that there is no consistent evidence that increases in insurance coverage rates among adults from 2008 to 2014 were associated with worsened access to care among adults who were continuously insured. "This lack of an apparent relationship held true across multiple measures of access to care, including receipt of preventive care," the study finds.
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