Héctor E Alcalá1, Dylan H Roby2, David T Grande3, Ryan M McKenna4, Alexander N Ortega4. 1. Department of Family, Population and Preventative Medicine, Stony Brook University, Stony Brook, NY. 2. Department of Health Services Administration, University of Maryland School of Public Health, College Park, MD. 3. Colonial Penn Center, University of Pennsylvania. 4. Department of Health Management and Policy, Dana and David Dornsife School of Public Health, Nesbitt Hall, Philadelphia, PA.
Abstract
BACKGROUND: Millions of adults have gained insurance through the Affordable Care Act (ACA). However, disparities in access to care persist. OBJECTIVE: This study examined differences in access to primary and specialty care among patients insured by private individual market insurance plans (both on-exchange and off-exchange) and Medicaid compared with those with employer-sponsored insurance. RESEARCH DESIGN: Using data from the 2014 and 2015 California Health Interview Survey, logistic regression analyses were used to calculate the odds of being unable to access primary care providers, access specialty care providers and receive a needed doctor's appointment in a timely manner, with insurance type serving as the independent variable. Interaction terms examined if the expiration of the ACA's optional Medicaid primary care fee increase in 2014 modified any of these associations. RESULTS: Findings showed poorer access to providers among those insured through Medicaid and the individual market (whether purchased through the state's health insurance exchange or off-exchange) relative to employer-based insurance. Poor access to primary care providers was seen among private coverage purchased via exchanges, relative to private coverage purchased on the individual market. In addition, findings showed that reduction of Medicaid fees coincided with reduced ability to see primary care providers. However, a similar trend was seen among those with employer-based coverage, which suggests that this change may not be attributable to reductions in Medicaid fees. CONCLUSION: Despite ACA-related gains in insurance coverage, those with on-exchange and off-exchange individual private insurance plans and Medicaid encounter more barriers to care than those with employer-based insurance.
BACKGROUND: Millions of adults have gained insurance through the Affordable Care Act (ACA). However, disparities in access to care persist. OBJECTIVE: This study examined differences in access to primary and specialty care among patients insured by private individual market insurance plans (both on-exchange and off-exchange) and Medicaid compared with those with employer-sponsored insurance. RESEARCH DESIGN: Using data from the 2014 and 2015 California Health Interview Survey, logistic regression analyses were used to calculate the odds of being unable to access primary care providers, access specialty care providers and receive a needed doctor's appointment in a timely manner, with insurance type serving as the independent variable. Interaction terms examined if the expiration of the ACA's optional Medicaid primary care fee increase in 2014 modified any of these associations. RESULTS: Findings showed poorer access to providers among those insured through Medicaid and the individual market (whether purchased through the state's health insurance exchange or off-exchange) relative to employer-based insurance. Poor access to primary care providers was seen among private coverage purchased via exchanges, relative to private coverage purchased on the individual market. In addition, findings showed that reduction of Medicaid fees coincided with reduced ability to see primary care providers. However, a similar trend was seen among those with employer-based coverage, which suggests that this change may not be attributable to reductions in Medicaid fees. CONCLUSION: Despite ACA-related gains in insurance coverage, those with on-exchange and off-exchange individual private insurance plans and Medicaid encounter more barriers to care than those with employer-based insurance.
Authors: Meera N Harhay; Ryan M McKenna; Suzanne M Boyle; Karthik Ranganna; Lissa Levin Mizrahi; Stephen Guy; Gregory E Malat; Gary Xiao; David J Reich; Michael O Harhay Journal: Clin J Am Soc Nephrol Date: 2018-06-21 Impact factor: 8.237
Authors: K John McConnell; Christina J Charlesworth; Jane M Zhu; Thomas H A Meath; Rani M George; Melinda M Davis; Somnath Saha; Hyunjee Kim Journal: J Gen Intern Med Date: 2019-10-28 Impact factor: 5.128
Authors: Andrea R Molino; Maria Lourdes G Minnick; Judith Jerry-Fluker; Jacqueline Karita Muiru; Sara A Boynton; Susan L Furth; Bradley A Warady; Derek K Ng Journal: Kidney Med Date: 2022-03-25
Authors: Sonali Saluja; Danny McCormick; Michael R Cousineau; Janina Morrison; Lisa Shue; Kyle Joyner; Michael Hochman Journal: Health Equity Date: 2019-08-23