Dive Brief:
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The increased number of insured Americans resulting from the passage of the Affordable Care Act (ACA) led to providers hiring more physicians, care coordinators and advanced practice clinicians to meet the higher demand, according to a new Robert Wood Johnson Foundation report.
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The Urban Institute, with funding from the foundation, interviewed healthcare stakeholders in five communities that experienced large increases in the number of insured.
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Researchers found that providers paid for staffing the added demand through revenue from newly insured patients, especially people covered by Medicaid. Health centers also received help from ACA grants.
Dive Insight:
About 20 million previously uninsured Americans gained coverage after the ACA. The Urban Institute researchers wanted to see how providers responded in regions that saw the largest increases in the number of insured. They focused on areas that were in states that expanded Medicaid: Detroit, Lexington, Kentucky; Sacramento, California; Spokane, Washington; and Morgantown, West Virginia.
The researchers found that those surveyed hired more advanced practice clinicians than primary care physicians and they added administrative and health information technology staff to help manage increased demand. They also expanded and upgraded existing facilities, and more urgent centers and retail clinics opened, too.
Those surveyed said they were able to meet increased demand, but there are still issues with not enough behavioral health, adult dental and specialty services in those areas.
Katherine Hempstead, senior advisor at the Robert Wood Johnson Foundation, said fears about providers not being able to keep up with more insured people were not realized. Instead, primary care providers “found ways to expand capacity by improving practice organization and care coordination.”
Though the percentage of uninsured Americans dropped after the ACA’s passage, that number is on the rise this year. Gallup recently reported that 12.3% of Americans are uninsured, which is the highest level since 2014. That was 1.4 percentage points higher than the end of 2016, which equals 3.5 million more Americans uninsured this year.
That number is expected to grow further next year. ACA supporters fear that President Donald Trump's administration's moves related to the ACA will depress enrollment. Over the past few months, the Trump Administration:
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Cut the ACA exchange plan open enrollment period in half.
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Reduced the ACA advertising budget by 90%.
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Threatened not to enforce the individual mandate that requires nearly all Americans to have health insurance.
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Stopped cost-sharing reduction payments to insurers in the exchanges, which will lead to higher premiums.
Critics fear that these moves will lead to fewer members, as people, especially those who are young and healthy, will not sign up for or will drop out of ACA plans. If those people flee the exchanges, payers' risk pools will become unbalanced, which will lead to higher premiums for those still in the exchanges.
That would be bad news for hospitals. Fewer insured Americans would likely mean more bad debt and charity care for hospitals and providers.