The Effect of the Affordable Care Act on Medicare Enrollees’ Access to Physician Services

Research Report

The Effect of the Affordable Care Act on Medicare Enrollees’ Access to Physician Services

August 20, 2019

Abstract

This study first analyzes trends in physicians’ acceptance of patients over time by Medicaid expansion status, state, and county. To examine changes in Medicare patients’ access to providers, compared to changes in access for Medicaid and privately insured patients, this analysis draws on two physician surveys, the National Ambulatory Medical Care Survey-National Electronic Health Records Survey (NAMCS-NEHRS) and SK&A physician database, each with different strengths and weaknesses. This analysis also estimates the impact of the ACA’s Medicaid expansion on physician acceptance of Medicare, Medicaid, and privately-insured patients by using a difference-in-differences approach to compare acceptance rates in Medicaid expansion rates with those in nonexpansion states. Overall, physician acceptance of Medicare patients—overall and across states and counties—remained about the same in most areas after implementation of the ACA coverage expansion. This analysis also finds that Medicaid expansion, relative to not expanding Medicaid, had no effect, or a slightly positive effect, on physicians’ acceptance rates. This finding is important for remaining states that have not yet expanded Medicaid who might be concerned that expansion could have negative spillover effects on other insured populations.

Each map highlights the variation across counties in the share of office-based physicians who accept Medicare patients. Overall, physician availability did not deteriorate from 2011 to 2016.

Percent of Office-Based Physicians Who Accept Medicare Patients, 2011 and 2016 SK&A Physician Database
 

Note: Data not shown for counties with fewer than 10 office-based physicians.

The sample includes ambulatory medical doctors and doctors of osteopathy in all 50 U.S. states and the District of Columbia, excluding those with pediatric specialties. Physicians that provide care in multiple sites are included in the sample for each county in which they practice. See report for additional details.

Research Area: 

Centers

To reuse content from Urban Institute, visit copyright.com, search for the publications, choose from a list of licenses, and complete the transaction.