Insurance Type and Access to Health Care Providers and Appointments Under the Affordable Care Act

Abstract

Despite ACA-related gains in insurance coverage, those with on-exchange and off-exchange individual private insurance plans and Medicaid encounter more barriers to care than those with employer-based insurance.

Racial Discrimination in Health Care and Utilization of Health Care: a Cross-sectional Study of California Adults

“…Controlling for location of usual source of health care did not impact this relationship. The disadvantage experienced by those with Medicaid and Medicare coverage may stem from a variety of factors, including having a harder time getting an appointment, 28 narrower provider networks, different services covered, longer patient wait- times, cost-sharing between patient and insurance, and receiving poorer service from health care providers and their staff based on the insurance they utilize. Thus, both interpersonal and structural factors may be at play.…”

“…While employer-sponsored coverage is a type of private insurance, we separate it from privately purchased coverage obtained through the individual market, because different categories of private insurance coverage have been shown to differentially impact access to health care. 28 Employersponsored coverage served as the reference category in analyses because this insurance type is associated with fewer barriers to health care and is the most common insurance type among Californians. 28 The second variable captured where the respondent went for their usual source of health care.…”

“…28 Employersponsored coverage served as the reference category in analyses because this insurance type is associated with fewer barriers to health care and is the most common insurance type among Californians. 28 The second variable captured where the respondent went for their usual source of health care. This was coded into five categories: (1) doctor's office, HMO, or Kaiser; (2) no usual source of care; (3) clinic, health center, or hospital clinic; (4) emergency room; or (5) other place or no one place.…”

“…[25][26][27] However, changes to insurance offerings and coverage introduced by the ACA did not eliminate disparities in access to care by insurance type. 28 For example, one recent study noted the varying size of insurance plans under the law, and found that Latinos were disproportionately in narrower plans with less choice of providers. 29 Thus, the changing menu of insurance options and influx of newly insured patients into the health care setting make it important to determine how insurance type is associated with experiences of racial or ethnic discrimination in health care.…”

Health care utilization and HIV clinical outcomes following Affordable Care Act implementation in California: A longitudinal study

“…One recent study in California found that those with employer-based insurance had greater access to providers than those with either on-exchange and off-exchange individual private insurance plans or Medicaid [31]. Consistent with our psychiatry utilization ndings, this study found worse access to primary care among those with private coverage purchased on exchanges compared to private coverage purchased individually [31]. Another study found that patients often felt overwhelmed by the array of choices offered on the exchanges and were confused by terminology and websites [32].…”