Most Primary Care Doctors See More Insured Patients Under ACA

June 19, 2015

On the eve of a Supreme Court decision that could cripple the Affordable Care Act (ACA), 59% of primary care physicians are seeing more patients who are newly insured through a private plan or Medicaid since the law dramatically expanded coverage in 2014, a new survey reports.

Of these physicians, 78% say that their ability to provide high-quality care to all patients has either remained the same or improved, according to the survey by the Kaiser Family Foundation (KFF) and the Commonwealth Fund.

KFF and the Commonwealth Fund, a health policy think tank, polled a national sample of 1624 primary care physicians along with 525 nurse practitioners and physician-assistants from January through March.

The survey results, released yesterday, inform the national discussion of what might happen if the Supreme Court strikes down premium subsidies in 34 states that didn’t establish their own insurance marketplaces, or exchanges, under the ACA, but instead defaulted to a federally established version. A lawsuit before the high court maintains that only individuals in states that created their own exchanges are eligible for the assistance, based on the ACA's wording.

Some 6.4 million individuals in the 34 hold-out states have received premium subsidies this year to purchase a private health plan through an exchange. A defeat for the Obama administration in this case could cause many if not most of them to lose their coverage. The court is expected to issue its decision by the end of June.

Expanded access to insurance and healthcare is the most popular aspect of the law among primary care physicians. Forty-eight percent said the ACA has had a positive impact in this area, while 24% see a negative one. However, the law receives higher negative ratings than positive for its effect on medical practice overall, the quality of patient care, the ability to meet patient demand, and the cost of care.

Like the rest of the nation, primary care physicians divide roughly down the middle in their opinion of the controversial law. Forty-eight percent said they had either a somewhat or very favorable view of the ACA compared with 52% who take an unfavorable view. In March, KFF found a similar split in the general public — 41% for the law and 43% against.

What primary care physicians think about the ACA correlates strongly to what political party they claim. Eighty-seven percent of Democrat primary care physicians favor the law, while 87% of their Republican counterparts object to it. Most physicians who identify themselves as independents also don't like the ACA (58%).

About Four in 10 Physicians Have Seen Patient Volume Rise

With ACA insurance exchanges having opened their doors for business last year and Medicaid expansion underway, the healthcare industry has wondered whether physicians would see more new patients as a result. In March, the Robert Wood Johnson Foundation and healthcare technology and services firm athenahealth reported the smallest of upticks in the percentage of new patient visits — 0.3% — among primary care providers in 2014.

The KFF-Commonwealth Fund survey sheds a little more light on the issue of patient volume under the ACA. Forty-four percent of primary care physicians said they're seeing more patients since January 2014, while volume has remained steady for another 38% and declined for 15%. However, the survey results do not specify the degree of increase or decrease.

At the same time, access to care appears to have shrunken slightly. The survey found that the percentage of primary care physicians accepting new patients slipped from 89% in late 2011 and early 2012 to 83% in 2015. The acceptance rate of new Medicaid patients decreased by a smaller rate — from 52% to 50% — during this period.

The survey is available on the KFF website.

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