A Flood of Newly Insured Patients: How Will States, Providers, and Health Systems Respond?

In January 2014, the Affordable Care Act (ACA) is estimated to grant more than 30 million individuals previously disengaged from the health care system the opportunity to access care, either through expanded Medicaid coverage or health insurance exchanges. The success of this landmark legislation relies on these newly insured Americans participating in this opportunity. However, health systems, providers, and policymakers are fearful that the volume of newly insured individuals will severely strain the health care system. Ian Hill from The Urban Institute, in conjunction with the Robert Wood Johnson Foundation, explores this pending challenge in “Will There Be Enough Providers to Meet the Need? Provider Capacity and the ACA.” Ian Hill analyzes qualitative interview data from Alabama, Colorado, Maryland, Minnesota, New Mexico, New York, Oregon, Rhode Island, and Virginia to determine how states hope to utilize provisions in the ACA to better serve this increase in patients.

A chief concern is that the health care system is ill-equipped to meet the primary care needs of such a large number of new patients. This is especially worrisome in states like Alabama, Colorado, and Virginia, where the number of uninsured is expected to decrease dramatically due to increased Medicaid coverage.

The Affordable Care Act aims to combat this potential problem via four types of provisions. First, the federal government is increasing Medicaid reimbursements to 100 percent of Medicare rates for primary care services. However, this increase will only last between 2013 and 2014. Second, the ACA allocated $11 billion for federally qualified health centers (FQHC), clinics that traditionally serve under and uninsured patients. These additional funds will allow these clinics to expand their services and provide care to a greater number of Medicaid and exchange-insured individuals. Third, the ACA increased funding for the National Health Service Corps by $1.5 billion. This increase will help 15,000 primary care providers (i.e., physicians, nurse practitioners, and physician’s assistants) pay back their school loans, if and only if they work in medically underserved areas. Finally, the ACA is funding innovative health service delivery models, such as Accountable Care Organizations and Patient-Centered Medical Homes, which aim to improve the efficiency and efficacy of health care delivery.

Through interviews with state officials, policymakers, insurers, and health care providers, Hill and his team learned that some of these provisions will prepare health providers and systems for the influx of new patients, while others will not be as valuable.  The increase in Medicaid reimbursements will help but only for two years. None of the states interviewed felt it was in a fiscal position to extend increases in primary care reimbursements after federal support ends. Almost all welcomed the increase in funding to FQHCs and believed that these clinics had the expertise to serve a larger Medicaid population. But a majority of states were not actively engaged in efforts to increase the primary care workforce. In fact, many efforts to expand the roles of nurse practitioners and physician assistants – so that these providers can care for patients without the supervision of a physician – have been actively thwarted by physician groups. All of the states indicated that efforts to innovate efficient and effective care delivery programs were in full swing. These efforts included telemedicine, text messaging for medication management, and statewide data sharing.

Overall, states are embracing the provisions in the ACA that aim to reduce the strain of newly insured patients on the health care system. The evidence of innovation and preparedness is encouraging and indicates that our health care system is equipped to confront this future challenge. But it is important to remember that these provisions are not a panacea for the challenges that states will face in 2014.

Feature Photo: cc/(Ed Uthman)