AMA survey shows how Medicaid expansion affected patient mix
- Physicians’ share of Medicaid and privately insured patients was higher in 2016 than in 2012 while their share of uninsured patients declined, according to the American Medical Association’s (AMA) 2016 Benchmark Survey. However, changes to the share of patients on Medicaid and the share of uninsured were only statistically significant in states that expanded Medicaid under the Affordable Care Act (ACA).
- In expansion states, the average Medicaid patient share grew from 16.2% to 17.6%. By contrast, there was no discernable change in Medicaid patient share in states that did not expand Medicaid.
- More striking was the change in uninsured. In expansion states, the percentage of doctors with uninsured patients dropped more than 7 percentage points, versus 2.2 percentage points in non-expansion states.
Among all physicians, the average share of Medicaid patients was 16.9% in 2016, up from 15.9% four years earlier. The number of doctors treating Medicaid patients also rose — from 81.9% to 82.6%. That share exceeded 90% for three hospital-based specialties — emergency medicine, anesthesiology and radiology — and was just under 90% for pediatrics, the survey shows.
The survey comes at a time when insurance rates are in the spotlight. Under the ACA, nearly 20 million Americans have become newly insured, reducing the burden of charity care on hospitals and other providers. However, efforts by President Donald Trump and Republicans in Congress to undo or undermine the law are chipping away at those gains. Earlier this month, Trump issued an executive order easing health plan benefit requirements and promised to eliminate cost-sharing subsidies to insurers. The dual attack on the ACA is likely to undermine the insurance exchanges and encourage payers to offer skinnier plans.
According to a new Gallup poll, the number of U.S. adults lacking health coverage rose 0.6% to 12.3% in the third quarter of this year, compared with the previous quarter — making it the highest since the fourth quarter of 2014. The biggest drop — 1.3 points to 21.3% — was among people with self-paid plans.
The AMA survey looked at patient mix numbers by practice type, and found direct hospitals employees reported higher than average shares of Medicaid and uninsured patients (16.6% and 9%) and below average privately insured patients (28.2%). Solo practitioners, on the other hand, averaged just 11.8% Medicaid patients and 46.7% private pay.
The survey also looks at physicians’ patient mix by major insurance type. Overall, doctors reported about 43.4% of patients on commercial insurance plans, 29.3% on Medicare, 16.8% on Medicaid, 6.1% uninsured and 4.3% covered by workers compensation or another form of payer. Medicare patients comprised larger shares for medical and surgical specialties, averaging nearly 40%.
- American Medical Association Physician Practice Benchmark Survey