Research Update: Checking Up on Health Care Utilization and Providers After the ACA’s Medicaid Expansion

This week, I am checking up on Medicaid research regarding health care utilization and providers. There is evidence that the expansion increased access and utilization of health care, led to an increase in smoking cessation, and increased the share of patients that physicians saw covered through Medicaid.

Health Services Research’s Impact of Recent Medicaid Expansions on Office-Based Primary Care and Specialty Care among the Newly Eligible

This study examines primary and specialty care for adults ages 26-64 at or below 138% FPL in expansion and non-expansion states using 2008-2014 data from the Medical Expenditure Panel Survey.

What it finds

  • In 2014, compared to adults in non-expansion states, newly eligible adults in expansion states were:
    • 9 percentage points more likely to have any office-based primary care physician visit
    • 7 percentage points more likely to have a specialist visit
    • 5 percentage points more likely to have a visit with a nurse practitioner, nurse, or physician assistant
  • There was no strong evidence of an increase in utilization among pre-ACA eligible adults.

Why it matters

  • The study suggests that the Medicaid expansion increased utilization of care and access to care.

Medical Care’s Medicaid Coverage Expansions and Cigarette Smoking Cessation Among Low-income Adults

This study examines smoking cessation for adults ages 18-64 and adults above 65 in expansion and non-expansion states using data from the Behavioral Risk Factor Surveillance Survey.

What it finds

  • There was an estimated 2.1 percentage point increase in the predicted probability of smoking cessation among low-income adults in expansion states compared to low-income adults in non-expansion states.
  • Low-income adults have disproportionately high rates of smoking, but engaging with the health care system may motivate them to stop smoking.

Why it matters

  • The Medicaid expansion, through improvements in access to health care, increases the probability of smoking cessation. This may lead to significant reductions in diseases and deaths linked to smoking.

The AMA’s Physicians’ Patient Mix – A Snapshot from the 2016 Benchmark Survey and Changes Associated with the ACA

The report uses the AMA’s Physician Practice Benchmark Survey to review physicians’ patient mix between 2012 and 2016.

What it finds

  • In 2016, physicians reported an average patient share of: 43% commercial, 29% Medicare, 17% Medicaid, 6% uninsured and 4% other.
  • In 2016, about 83% of physicians treated Medicaid patients.
  • The percent of physicians treating Medicaid patients increased from about 82% in 2012 to 86% in 2016. The share of Medicaid patients that physicians see increased from 16% to 17% during the time period.

Why it matters

  • As Say Ahhh! readers know, Medicaid is a children’s program (more than 40% of Medicaid enrollees are children). Pediatricians had a Medicaid patient share of 35% in 2016, which was more than double the average. Pediatricians treated the highest share of Medicaid patients of any specialty.
  • The Medicaid expansion decreased the share of uninsured patients treated by providers. The percent of physicians with uninsured patients fell by more than 7 percentage points in expansion states, compared to only 2 percentage points in non-expansion states. In 2016, about 30% of physicians in expansion states did not have uninsured patients, compared to only 16% in non-expansion states. Providers in expansion states also had a significant increase in the share of their patients covered through Medicaid during the time period.

Find more Research Updates here.