Is the Affordable Care Act Helping Consumers Get Health Care?

Findings from the Commonwealth Fund Affordable Care Act Tracking Survey, March–June 2017

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    Two-thirds of people who used their ACA plan to get care wouldn’t have been able to get this care prior to enrolling
    Most people with coverage through the ACA marketplaces or Medicaid are satisfied with their choice of doctors

With the Affordable Care Act (ACA)’s open enrollment period for marketplace plans under way, most attention has focused on the cost of this coverage. But what about consumers’ views about the doctors covered by their insurance and their ability to get timely care from primary care physicians and specialists?ACA Tracking Survey

The Commonwealth Fund’s Affordable Care Act Tracking Survey provides some answers. Between March and June 2017, the survey research firm SSRS contacted a random, nationally representative sample of 4,813 U.S. adults ages 19 to 64, including 1,204 adults ages 19 to 64 who had either marketplace or Medicaid coverage. The survey’s overall margin of error is +/– 1.8 percentage points at the 95 percent confidence level. Learn more about the survey methods.

HIGHLIGHTS

Adults enrolled in an Affordable Care Act marketplace plan or in Medicaid were asked about:

  • Access to care 65 percent who used their coverage to get health care reported they would not have been able to access or afford this care prior to enrolling.
  • Network satisfaction 87 percent were satisfied with the doctors covered by their current insurance.
  • Finding a new physician 64 percent who tried to find a new primary care doctor since getting their insurance said it was somewhat or very easy to do so.
  • Getting appointments 74 percent who tried to get a primary care doctor appointment and 59 percent who tried to get a specialist appointment found one within two weeks.

Eight of 10 adults (79%) enrolled in a marketplace plan or in Medicaid said they had used their coverage to go to a doctor, hospital, or other health care provider or to fill a prescription (data not shown). Of this group, 65 percent said they would not have been able to access or afford this care prior to getting this coverage. People enrolled in Medicaid, those previously uninsured, and those with low incomes were significantly more likely than comparison groups to say they could not have accessed or afforded this care before.

Most enrollees (87%) with marketplace or Medicaid coverage reported being very or somewhat satisfied with the doctors covered by their insurance. There was no difference in satisfaction between marketplace and Medicaid enrollees.

Most marketplace and Medicaid enrollees say that their health plan networks include all or some of the doctors they want.

One-quarter of marketplace and Medicaid enrollees have tried to find a new primary care or general doctor since getting their insurance (data not shown). Of this group, 64 percent said it was somewhat or very easy to find one. That is similar to rates seen in other studies for insured adults overall who had coverage for the full year.1

About three-quarters of marketplace and Medicaid enrollees who found a new primary care doctor could get an appointment with that doctor within two weeks the last time they tried. Again, this is similar to wait times reported by continuously insured adults in other surveys.2

Wait times for specialists also largely mirrored rates found for other insured adults.3 Half of marketplace and Medicaid enrollees needed to see a specialist during the time they had their coverage (data not shown). Of those, 59 percent could secure an appointment within two weeks.

Among adults who had changed their marketplace plans, only 10 percent did so to get more of the doctors or hospitals they wanted. But more than one-third (35%) switched plans because their old plan was no longer being offered, while 21 percent switched to get a lower premium. Another third (34%) said they switched for some other reason.4

Only 10 percent of marketplace enrollees who have kept their same plan said they did so because they liked the doctors in their network.

Forty-six percent of people with marketplace coverage said they had the option of choosing a less expensive plan with a limited provider network of doctors and hospitals. Of those, 45 percent selected that plan.

While health plans sold in the marketplace must link to provider directories, consumers have the most difficulty comparing health plans on this dimension.



How We Conducted This Study

The Commonwealth Fund Affordable Care Act Tracking Survey, March–June 2017, was conducted by SSRS from March 28–June 20, 2017. The survey consisted of 15-minute telephone interviews in English or Spanish and was conducted among a random, nationally representative sample of 4,813 adults, ages 19 to 64, living in the United States. Overall, 1,198 interviews were conducted on landline telephones and 3,615 interviews on cellular phones.

This survey is the fifth in a series of Commonwealth Fund surveys to track the implementation and impact of the Affordable Care Act. The first was conducted by SSRS from July 15 to September 8, 2013, by telephone among a random, nationally representative U.S. sample of 6,132 adults ages 19 to 64. The survey had an overall margin of sampling error of +/– 1.8 percent at the 95 percent confidence level.

The second survey in the series was conducted by SSRS from April 9 to June 2, 2014, by telephone among a random, nationally representative U.S. sample of 4,425 adults ages 19 to 64. The survey had an overall margin of sampling error of +/– 2.1 percent at the 95 percent confidence level. The sample for the April–June 2014 survey was designed to increase the likelihood of surveying respondents who were most likely eligible for new coverage options under the ACA. As such, respondents in the July–September 2013 survey who said they were uninsured or had individual coverage were asked if they could be recontacted for the April–June 2014 survey. SSRS also recontacted households reached through its omnibus survey of adults who were uninsured or had individual coverage prior to the first open enrollment period for 2014 marketplace coverage.

This third survey in the series was conducted by SSRS from March 9, 2015 to May 3, 2015 by telephone among a random, nationally representative U.S. sample of 4,881 adults, ages 19 to 64. The March–May 2015 sample was also designed to increase the likelihood of surveying respondents who had gained coverage under the ACA. SSRS recontacted households reached through their omnibus survey of adults between November 5, 2014 and February 1, 2015 who were uninsured, had individual coverage, had a marketplace plan, or had public insurance. The survey has an overall margin of sampling error of +/– 2.1 percentage points at the 95 percent confidence level.

The fourth survey in the series was conducted by SSRS from February 2, 2016 to April 5, 2016 by telephone among a random, nationally representative U.S. sample of 4,802 adults, ages 19 to 64. The February–April 2016 sample was also designed to increase the likelihood of surveying respondents who had gained coverage under the ACA. Interviews in wave 4 were obtained through two sources: 1) stratified RDD sample, using the same methodology as in waves 1, 2 and 3; and 2) households reached through the SSRS omnibus where interviews were previously completed with respondents ages 19 to 64 who were uninsured, had individual coverage, had a marketplace plan, or had public insurance. The survey has an overall margin of sampling error of +/– 2.0 percentage points at the 95 percent confidence level.

The March–June 2017 sample was also designed to increase the likelihood of surveying respondents who had gained coverage under the ACA. Interviews in wave 5 were obtained through two sources: 1) stratified RDD sample, using the same methodology as in waves 1, 2, 3 and 4; and 2) households reached through the SSRS omnibus where interviews were previously completed with respondents ages 19 to 64 who were uninsured, had individual coverage, had a marketplace plan, or had public insurance.

As in all waves of the survey, SSRS oversampled adults with incomes under 250 percent of poverty to further increase the likelihood of surveying respondents eligible for the coverage options as well as allow separate analyses of responses of low-income households.

The data are weighted to correct for oversampling uninsured and direct purchase respondents, the stratified sample design, the overlapping landline and cellular phone sample frames, and disproportionate nonresponse that might bias results. The data are weighted to the U.S. 19-to-64 adult population by age, by state, gender by state, race/ethnicity by state, education by state, household size, geographic division, and population density using the U.S. Census Bureau’s 2015 American Community Survey. Data are weighted to household telephone use parameters using the CDC’s 2014 National Health Interview Survey.

The resulting weighted sample is representative of the approximately 190 million U.S. adults ages 19 to 64. Data for income, and subsequently for federal poverty level, were imputed for cases with missing data, utilizing a standard regression imputation procedure. The survey has an overall margin of sampling error of +/– 2.1 percentage points at the 95 percent confidence level. The landline portion of the main sample survey achieved a 16.5 percent response rate and the cellular phone main-sample component achieved a 9.7 percent response rate. The overall response rate, including the prescreened sample, was 9.6 percent.


Notes

1 In the Commonwealth Fund Biennial Health Insurance Survey, 2016: among adults who were insured all year and had tried to find a primary care provider, 62 percent said it was somewhat or very easy to find one (unpublished data). Similarly in the Commonwealth Fund Biennial Health Insurance Survey, 2014, among adults who were insured all year and had tried to find a primary care provider, 57 percent said it was somewhat or very easy to find one.

2 In the Commonwealth Fund Biennial Health Insurance Survey, 2016: among adults who were insured all year and had tried to find a primary care provider, 58 percent said they were able to book an appointment within two weeks (unpublished data). In the Commonwealth Fund Biennial Health Insurance Survey, 2014, among adults who were insured all year, 56 percent of those who found a new primary care doctor got an appointment within two weeks. Similarly, a 2011 Commonwealth Fund survey of adults ages 19–64 found that among those insured all year who had tried to find a primary care physician in the past three years (either respondent or spouse/partner), 57 percent got an appointment within two weeks, including 35 percent who got an appointment within 1 week and 22 percent within one to two weeks. See S. R. Collins, R. Robertson, T. Garber, and M. M. Doty, The Income Divide in Health Care: How the Affordable Care Act Will Help Restore Fairness to the U.S. Health System (The Commonwealth Fund, Feb. 2012).

3 In the Commonwealth Fund Biennial Health Insurance Survey, 2016: among adults who were insured all year and needed to see a specialist, 61 percent said they were able to book an appointment within two weeks (unpublished data). Similarly, in the 2013 Commonwealth Fund International Health Policy Survey, among continuously insured adults ages 18–64, 42 percent of U.S. adults who needed to see a specialist reported that they were able to get an appointment in one week or less.

4 “Other reasons” include, but are not limited to: the respondent’s new plan having a lower deductible; income changes for the respondent which would allow them to purchase a more or less expensive plan; employment changes for the respondent; or marital changes for the respondent.

Publication Details

Publication Date: December 6, 2017
Authors: Munira Z. Gunja, Sara R. Collins, Herman K. Bhupal
Contact: Munira Z. Gunja, Senior Researcher, Health Care Coverage and Access, The Commonwealth Fund
E-mail: mg@cmwf.org
Editor:
Christopher Hollander
Citation:
M. Z. Gunja, S. R. Collins, and H. K. Bhupal, Is the Affordable Care Act Helping Consumers Get Health Care? The Commonwealth Fund, December 2017.

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