Most Uninsured Adults Could Schedule Primary Care Appointments Before The ACA, But Average Price Was $160.
Provisions of the Affordable Care Act (ACA) allow millions more Americans to obtain health insurance. However, a sizable number of people remain uninsured because they live in states that have not expanded Medicaid coverage or because they feel that Marketplace coverage is not affordable. Using data from a ten-state telephone survey in which callers posed as patients, we examined prices for primary care visits offered by physician offices to new uninsured patients in 2012-13, prior to ACA insurance expansions. Patients were quoted a mean price of $160. Significantly lower prices for the uninsured were offered by family practice offices compared to general internists, in offices participating in Medicaid managed care plans, and in federally qualified health centers. Prices were also lower for offices in ZIP codes with higher poverty rates. Only 18 percent of uninsured callers were told that they could bring less than the full amount to the visit and arrange to pay the rest later. ACA insurance expansions could greatly decrease out-of-pocket spending for low-income adults seeking primary care. However, benefits of health reform are likely to be greater in states expanding Medicaid eligibility.
Brendan Saloner (bsaloner@gmail.com) is an assistant professor in the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland.
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Daniel Polsky is a professor of medicine in the Division of General Internal Medicine, the Robert D. Eilers Professor in Health Care Management and Economics at the Wharton School, and executive director of the Leonard Davis Institute of Health Economics, all at the University of Pennsylvania, in Philadelphia.
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Genevieve M. Kenney is a senior fellow at and codirector of the Health Policy Center, Urban Institute, in Washington, D.C.
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Katherine Hempstead is a director at the Robert Wood Johnson Foundation, in Princeton, New Jersey, and a visiting research assistant professor in the Rutgers Center for State Health Policy, in New Brunswick, New Jersey.
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Karin V. Rhodes is director of the Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, and a senior fellow in the Leonard Davis Institute of Health Economics, both at the University of Pennsylvania.
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D005194:Family Practice / Q000191:economics; D005260:Female; D058006:General Practice / Q000191:economics; D005102:Health Expenditures / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000191:economics*; D006302:Health Services Research; D006801:Humans; D007388:Internal Medicine / Q000191:economics; D008297:Male; D008484:Medicaid / Q000191:economics; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D009819:Office Visits / Q000191:economics*; D058991:Patient Protection and Affordable Care Act / Q000191:economics*; D011204:Poverty Areas; D011320:Primary Health Care / Q000191:economics*; D014481:United States
Access To Care; Cost of Health Care; Insurance Coverage < Insurance; Primary Care