Primary Care Appointment Availability Increased for New Medicaid Patients Under ACA

Despite concerns that an influx of newly insured patients from the expansion of Medicaid under the Affordable Care Act (ACA) could make it more difficult for new patients to get a primary care appointment, availability remained stable for privately insured patients and actually increased for Medicaid beneficiaries.

During the initial study wave in 2012-2013, researchers called a sample of primary care practices in 10 states posing as new patients with either private insurance or Medicaid. They logged whether they could make an appointment and, if so, the time in days from the call to the scheduled appointment. The process was repeated in 2016, after the ACA had been fully implemented, using an updated sample of practices. The results were published in JAMA Internal Medicine.

Appointment availability for the Medicaid “patients” increased 5.4 percentage points from the baseline, but short wait times of a week or less decreased by 6.7 percentage points. There was no significant difference in appointment availability for the callers with private insurance, although short wait times decreased 4.1 percentage points and long wait times of more than 30 days increased by 3.3 percentage points. During the follow-up period, availability rates for Medicaid patients were still lower than those for the privately insured, but this disparity had narrowed over the years.

According to the researchers, these findings suggest that fears of reduced access under the ACA were likely unfounded. Instead, it became easier for Medicaid patients to make an appointment with a new primary care provider despite the flood of additional patients. The study authors suggest that practices may have adapted their practices to efficiently manage the increased volume by instituting “shorter visits and more rigorous management of no-shows.”

They acknowledged that the longer wait times from call to appointment were an unavoidable result of the influx of patients, noting that Massachusetts had experienced a similar effect in 2006 when it expanded Medicaid. Still, the improved availability of appointments was an encouraging signal that policy efforts like increased Medicaid reimbursement rates had successfully equipped providers to accept additional new patients.

The study authors also noted that other trends not related to the ACA may have helped providers expand their capacity, such as team-based care structures, strengthened data sharing among practices, and the increased availability of retail clinics.