title: Primary Care Appointment Availability and the ACA Insurance Expansions.
abstract: In the current debate in Congress over the Affordable Care Act (ACA), the issue of provider access is a major concern. Fortunately, our 10-state audit study published in JAMA Internal Medicine finds that primary care appointment availability for new patients with Medicaid increased 5.4 percentage points between 2012 and 2016 and remained stable for patients with private coverage. Over the same period, both Medicaid patients and the privately insured experienced a one-day increase in median wait times.
  Higher appointment availability for Medicaid patients is a surprising result given the increase in demand for care from millions of new Medicaid enrollees. In this Issue Brief, we summarize our study’s findings, expand on possible explanations, and extend the analysis by examining the relationship between appointment availability and state-level Medicaid expansions. We find that access to primary care increased for Medicaid patients only in states that extended Medicaid eligibility to low-income, nonelderly adults. Combined, these results suggest coverage provisions in the ACA have not overwhelmed primary care capacity.
authors.affiliation: Leonard Davis Institute of Health Economics, Philadelphia, PA, USA.
authors.forename: Molly
authors.initials: M
authors.lastname: Candon
authors.affiliation: Leonard Davis Institute of Health Economics, Philadelphia, PA, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Polsky
authors.affiliation: Johns Hopkins Bloomberg School of Public Health.
authors.forename: Brendan
authors.initials: B
authors.lastname: Saloner
authors.affiliation: Urban Institute.
authors.forename: Douglas
authors.initials: D
authors.lastname: Wissoker
authors.affiliation: Robert Wood Johnson Foundation.
authors.forename: Katherine
authors.initials: K
authors.lastname: Hempstead
authors.affiliation: Urban Institute.
authors.forename: Genevieve M
authors.initials: GM
authors.lastname: Kenney
authors.affiliation: Northwell Health Office of Population Health, Leonard Davis Institute of Health Economics, Philadelphia, PA, USA.
authors.forename: Karin
authors.initials: K
authors.lastname: Rhodes
mesh_terms: D000328:Adult; D005544:Forecasting; D006297:Health Services Accessibility / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data / Q000639:trends; D008484:Medicaid / Q000706:statistics & numerical data* / Q000639:trends; D008875:Middle Aged; D058991:Patient Protection and Affordable Care Act / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data* / Q000639:trends; D013997:Time Factors; D014481:United States; D014850:Waiting Lists