Policy & Regulation News

Does the ACA Drive Patient Access to Primary Preventive Care?

Primary preventive care access increased from 59 percent to 73 percent under ACA health insurance access.


Source: Thinkstock

By Sara Heath

- Healthcare coverage via the Affordable Care Act (ACA) has increased the number of patients receiving primary preventive care, according to research published in the American Journal of Managed Care.

“A major goal of the Affordable Care Act (ACA) is to increase access to healthcare, particularly for those who are uninsured, underinsured, or without stable healthcare insurance,” the researchers explained. “However, there has been significant debate as to whether the ACA has achieved its goals of improving access and decreasing costs and whether it should continue in its current form.”

The research team looked at the quality of newly-accessible healthcare, and not just the total volume of patients receiving care under the law.

In a survey of 2,145 patients, the team looked at care experience improvements before and after receiving healthcare services over the California and Colorado health insurance exchanges. The team surveyed patients receiving coverage through Kaiser Permanente by January 1, 2014.

Researchers conducted a baseline survey that asked about prior healthcare experiences and self-engagement in preventive care. They also conducted a one-year follow-up survey consisting of the same questions.

Overall, the researchers found that the ACA has increased the number of patients who are visiting a regular primary care physician, being encouraged to quit smoking, and who feel confident in having a provider to visit in a medical emergency.

Primary care physician access increased from 59 percent to 73 percent over the test period. Preventive care strategies, such as receiving a flu shot, also rose from 41 percent to 52 percent of patients.

The law decreased the number of patients delaying treatment due to healthcare costs from 37 percent to 25 percent of patients.

These results were more pronounced in patients who had less than four months of contiguous healthcare coverage in 2013, the year before the survey.

Fifty-six percent of those patients felt like they had a consistent facility at which they could receive healthcare, compared to 43 percent of those patients the year before. Seventy-two percent of those patients received advice to quit smoking versus 46 percent of patients the year prior.

“These findings are an important addition to the evidence base that the ACA is improving the healthcare experience and reducing barriers due to costs for individuals obtaining insurance coverage through the healthcare exchanges,” the researchers said.

Although the study was limited in health insurance type, the researchers maintained that its results are relevant nonetheless.

“Although our study was conducted among ACA enrollees in systems whose cost-sharing structures might not represent all exchange plans, our finding that delays in receiving needed medical care were reduced after enrolling through the ACA exchanges is particularly important in light of the fact that many exchange insurance products offered are high-deductible health plans that involve significant cost sharing for patients until the deductible is met,” explained the researchers.

Other recent research has pointed to the ACA’s effectiveness in driving patient healthcare access. Earlier this year, the Journal of the American Medical Association Internal Medicine published a study showing that primary care access has increased between 2013 and 2016, thanks to the law.

Medicaid primary care appointments increased by 5.3 percent during that time period.

Primary care appointments with short wait times, defined as less than one week, decreased for both Medicaid and privately insured patients, lowering by 6.7 and 4.1 percentage points, respectively. Long wait times, defined as more than 30 days, increased for privately insured patients by 3.3 percentage points.

“The appointment availability results should ease concerns that the Affordable Care Act would exacerbate the primary care shortage,” the researchers said. “Primary care practices may be adapting to an influx of new patients with shorter visits and more rigorous management of no-shows.”

The law’s critics say the ACA has hindered patient healthcare access by driving high deductibles and premiums, posing financial barriers to healthcare.

Research also shows that many patients are not accessing treatment when necessary due to high costs and some experts maintain that alterations to or repeal of the law will help mitigate those cost barriers.


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