Affordable Care Act, healthcare, Obamacare — July 22, 2015 at 7:06 pm

Michigan Medicaid expansion increases doctor appointment availability, defying expectations

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Study shows that access to physicians went up, not down — exactly the opposite of what ACA opponents predicted.


Once again, the Affordable Care Act (ACA) is proving its critics wrong. Opponents of the ACA, or Obamacare, have been falling all over themselves proclaiming that an influx of new patients will overburden the healthcare system, creating a dire doctor shortage.

At least in Michigan, that’s not happening.

A new University of Michigan study shows that the availability of primary care appointments actually improved for people with Medicaid in the first months after the state launched the Healthy Michigan Plan, the state’s Medicaid expansion under the ACA. What’s more, it remained mostly unchanged for those with private insurance.

In a paper published in the journal Health Affairs, the team from the U-M Institute for Healthcare Policy and Innovation reports the results of a “secret shopper” study that measured the availability of primary care appointments.

Research team members called hundreds of clinics posing as relatively healthy patients looking for a routine checkup with a new health provider. For those who said they had Medicaid, 49 percent of clinics offered an appointment before the expansion and 55 percent offered an appointment after expansion. For those who posed as patients with private insurance, 88 percent of clinics said they could take them before expansion and 86 percent said they could after expansion.

Overall, wait times for the first available appointment for all patients stayed the same as before the Medicaid expansion took effect, at about a week.

This isn’t just important because Obamacare naysayers predicted that everyone would be left without adequate access to care after an influx of newly insured patients. During the first few months of Medicaid expansion, when he study was conducted, more than 350,000 people — one-third of the previously uninsured working-age adults in the state — joined the Healthy Michigan Plan.

It’s also important because of a caveat that was built into the Healthy Michigan Plan in order to convince recalcitrant Republicans to vote for Medicaid expansion. There’s a requirement that Healthy Michigan Plan recipients see a primary care provider within three months of getting covered, or risk getting kicked out of the program.

This requirement, combined with larger-than-predicted numbers of people enrolling in the Healthy Michigan Plan, had caused some concern that doctor’s appointments would be hard to get.

That’s what motivated the U-M team to study the issue, with funding from the Blue Cross Blue Shield of Michigan Foundation and the Robert Wood Johnson Foundation.

And this is what they found, per study lead author Renuka Tipirneni, M.D., M.S., a clinical lecturer in the Division of General Medicine at the U-M Medical School and a recent Robert Wood Johnson Foundation Clinical Scholar at U-M.

We expected that if practices were getting full due to Medicaid expansion and an increase in private insurance under the ACA, we would see decreased availability of appointments and longer wait times. In fact, we saw the opposite happen.

There were a few exceptions. At some clinics, new patients had to wait months for an appointment. “The clinics that had long wait times for new patient appointments had long waits for everyone,” says Tipirneni.

But overall, the news is good, says Matthew M. Davis, M.D., MAPP, senior author of the study and professor of pediatrics, internal medicine, public policy and public health at U-M.

Getting appointments as new patients is a challenging process. This study illustrates that although fewer practices accept Medicaid than accept private insurance, expanding access to coverage in Michigan has not made it more difficult to get an appointment as a new patient. That is good news for patients in Michigan.

Although there was a small drop in the percentage of clinics that were taking new privately insured patients after Medicaid expansion, this didn’t result in an overall increase in wait times. However, the researchers noted that it wasn’t possible to conclude from this study if new patients with private insurance were being displaced by those with Medicaid, something they hope to study in the future. They also called for further research to determine “whether increased access to care will persist in Michigan, and whether access to primary care for new patients with Medicaid in other states will follow similar patterns,” according to Health Affairs.

The U-M Institute for Healthcare Policy and Innovation has a separate state contract to evaluate the overall impact of the Healthy Michigan Plan. Since the ACA is, in part, about improving outcomes and accountability, here’s hoping this kind of research continues, both in Michigan and across the country.

Enrollment in the Healthy Michigan Plan is available to eligible Michigan residents year-round.

[Image credit: Vic, via Flickr.]

  • Don_K

    I know anecdotes aren’t data, but i’d say PCP appointments for me and my husband are substantially harder to get now than they were a year or so ago. First available for routine follow-up (nothing acute) tends to be 2-4 weeks out. And specialists are 6-8 weeks. I just chalked it up to there being a lot of pent-up demand and figured it was a minor annoyance in the grand scheme of things.

    • judyms9

      Pent up demand, as you say, is probably straining resources right now. The most ill who require a lot of care in order to stabilize should be at maintenance level by next year.

    • Amy Lynn Smith

      I haven’t noticed any change in how long it takes me to get in to my PCP or specialists. I am interested to see if U of M or anyone does further research to see how this is playing out in other states over the longer term, but I’m include to agree with Judy that any slight disruption will equalize pretty quickly.

      • Don_K

        Well, as I should have said, the plural of anecdote isn’t data; I’m just reporting what I’ve seen. As you say, things should sort themselves out after a while, and in any event I’m not a Republican sociopath (but I repeat myself) who begrudges non-rich people access to doctors and treatment

        • Amy Lynn Smith

          Oh, definitely, I’m agreeing with you Don, and just sharing my own anecdotes. :) I think we all want more care for everyone.

  • run75441

    I have regular insurance and it is the same wait time and always has been at U of M Domino Farms Since I am also in system at the VA and go yearly, I get in in less than 60 days for routine visit with PC doctor. Stories on the VA are mostly wrong. Longman does some nice reporting on the VA.

    Charles Gaba mentioned you in his blog so I thought I would stop by and read. Nice job of detailing Michigan. I always loved to poke holes in “sick to my stomach” Joe Hune on the PPACA and the Medicaid Expansion. The Senate Commission report provided enough data to refute the naysayers in passing it.

    I write for Angry Bear and occasionally with Maggie Mahar who knows far more than I do on the topic. I will be back from time to time.

    • Thank you and welcome!

      Charles is our web host: )

      • run75441

        Hi Amy:

        We do pull time to time from other blogs to feature on Angry Bear.

        Our writers feature on Social Security, Medicare, Disability (SS) with the main thrust on Economics. We do get picked up from time to time by DeLong, Economists View, Naked Capitalism and occasionally by Krugman. Many of us are economists, professional business, lawyers, doctors, profs, and normal everyday people. AB is a small blog; but, we do have a sound national presence.

        If it is ok, I will probably pull from Electablog the same as I do from Charles’s blog occasionally.

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