Health Coverage Expansion Could be a Trade-Off for Care

One concern about the Affordable Care Act is that as more Americans get health insurance and start using it, those who already have coverage will have to wait longer for care.

Recent research with a focus on Massachusetts suggests this may actually happen, but may not last long. Several years after the coverage expansion in that state, access to care for other, previously covered residents appears to be no worse than before the expansion.

Coverage expansion would present this potential trade-off if the supply of care (the number of doctors or their productivity) does not expand to meet the greater demand for it from the newly insured.

Increasing coverage is likely to increase demand for care. A longstanding finding in the research literature is that uninsured people avoid and delay care more than insured people do, and that this can harm health. According to Gallup, uninsured Americans are about twice as likely as insured Americans to delay care, and about 30 percent have put off care because of costs. A large body of research on the effects of the coverage expansion in Massachusetts found that it increased access to care for previously uninsured residents. For example, residents in that state were almost 5 percent less likely to forgo care, compared with the expected rate without the expansion.

But improving access to care for the uninsured doesn’t necessarily reduce access for everyone else, according to a new study published in the journal Health Services Research and led by Dr. Karen Joynt of Harvard. The authors found that neither receipt of outpatient services nor quality of care suffered when coverage expanded under the state’s health overhaul, which started in 2007. The findings, which are consistent with previous work by the same authors, are based on analysis of changes in receipt of outpatient care from 2006 to 2009 for elderly Medicare beneficiaries with chronic illnesses in Massachusetts, as compared with those in other New England states.

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Jeffrey R. Ungvary President

Jeffrey R. Ungvary