Urban Institute report maps how providers responded to increased demand under the Affordable Care Act

A signpost with the words Affordable Care Act
Healthcare providers expanded hours, hired staff, and opened new facilities to meet demand from newly insured patients under the ACA, reports the Urban Institute. (Getty/kroach)

A new Urban Institute report documents the ways in which healthcare providers expanded their capacity to accommodate newly insured patients after the passage of the Affordable Care Act. It also notes persistent gaps in coverage and near-term threats to the ability of providers to maintain that higher capacity over time.

The report forms part of a broader effort undertaken in May 2011 by the Urban Institute with the support of the Robert Wood Johnson Foundation, which looked at changes sparked by the implementation of healthcare reform in the United States. Through interviews, researchers developed a snapshot of how stakeholders in five communities adapted to spikes in the number of insured patients after Medicaid expansion under the ACA.

In general, researchers found that systems hired new staff and opened new facilities to accommodate the increased demand brought about by newly insured patients. Notably, some of the financial burden of those capacity increases was offset by changes in payer mix at safety-net hospitals, with a rise in patients covered under Medicaid and a drop in the number of uninsured patients reducing those facilities’ losses on uncompensated care. Some providers also extended operating hours at existing centers to meet demand.

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Despite those efforts, however, the report notes significant areas in which supply still lags demand. The ongoing shortage of primary care physicians has reportedly strained existing providers, raising concerns about burnout. Many providers also reported unmet needs in the area of behavioral health, an issue of particular concern as they attempt to respond to the ongoing opioid epidemic.

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When asked about ongoing challenges, most respondents raised issues related to healthcare reform proposals that target Medicaid expansion or seek cuts to Medicaid funding compared to current law.

Specific concerns included a deterioration in population health as patients seek less preventive care and return to over-reliance on acute care facilities like hospitals for nonemergency medical needs. Others, particularly those in Kentucky and West Virginia, warned of detrimental loss of coverage for patients in treatment for opioid addiction.

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