Physician practices have largely not been overwhelmed since the Affordable Care Act's individual mandate went into effect last year, contrary to concerns raised by ACA critics about the potential flood of new patients the law would bring.
The proportion of new-patient visits at primary-care providers increased by only .3 percentage points between 2013 and 2014 and no evidence surfaced that cases were significantly more complex, according to a new report, part of a series called ACAView. The study, results of which were released Wednesday, was prepared by athenahealth, the Watertown, Mass.-based cloud-based software provider, and funded by the Robert Wood Johnson Foundation.
Providers are conducting a higher proportion of comprehensive new-patient assessments, however. These increased 4.5% in the period examined. Data from the report comes from athenahealth's customers, which tend to be larger practices.
Before the mandate went into effect, industry leaders had concerns that the influx of newly insured patients could be too much for American physicians to handle, said Katherine Hempstead, the foundation's director of health insurance coverage. But the study shows that has not been the case, she said.
“It shows that the delivery system does not appear to be overwhelmed by the overextension in coverage,” Hempstead said. “The rise in new patients is not of a magnitude that would cripple the delivery system.”
The report also examined uninsured rates among practice customers. The proportion of uninsured patient visits dropped from 4.6% to 2.8% in the year the mandate went into effect, according to the report. Gallup reported in January that the U.S. uninsured rate dropped by 4.2 percentage points about a year after the individual mandate went into effect.
Among 100,000 patients who stayed with their physician and were uninsured for at least part of 2012-2014, 36.5% gained insurance after the mandate went into effect, compared with 27.8% who gained insurance the year before.
The insurance rate among this small sample of patients was even more pronounced among individuals in states that expanded Medicaid: 57% of individuals in expansion states gained insurance in 2014, compared with 34.8% the year before. In non-expansion states, 36.5% of patients gained insurance in 2014, compared with 27.8% the year before.
Before the mandate, fewer uninsured adults in older age brackets obtained insurance, but following the mandate, such age disparities seem to have evened out in 2014, the report said.
Provider data shows that, despite the increase in Medicaid enrollment in non-expansion states, doctors are seeing proportionally fewer Medicaid patients. The proportion of provider visits made by Medicaid patients in the non-expansion states actually declined 10.8% between 2013 and 2014.
“We speculate that providers in non-expansion states may have prioritized seeing new patients with commercial coverage obtained through the exchanges over patients who gained coverage through Medicaid,” the report said.
Even though physician payer mix tends to be very stable, practices in expansion states saw their proportion of Medicaid patients increase rather quickly, from 12.2% of all primary-care visits in December 2013 to 15% in March 2014. The Medicaid mix peaked at 16.7% in September before declining to 15.5% in December.
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