Does growing insurance coverage under the Affordable Care Act (ACA) reduce access to care for the insured?
We examine whether access to care has improved or deteriorated for adults in 2014, using Medical Expenditure Panel Survey (MEPS). The MEPS collects detailed measures of aspects of access that may be especially affected by supply. These measures are how easy it is to: get appointments for routine care, get care needed right away, get appointment with specialists, and get needed care, tests or treatments. The MEPS also asks about having a usual source of care and unmet needs and delays in getting medical care.
Using the MEPS two year panels and the linkage to the National Health Interview Survey, we identify adults who had the same source of insurance in 2013 and in 2014, and analogously for older panels. Pooling 7 years (2008 to 2014), we regress access measures on the growth in the number of insured, demographic and socioeconomic variables, and state fixed effects. This specification allows us to use changes in the percent insured related to program expansions and contractions before and in 2014. Measures of insurance growth from the American Community Survey provide additional sub-state variation. We also estimate specifications with discrete variables for geographic unit-years with large increases in insurance coverage. Effects may also depend on the number of physicians per capita, so we test for interactions between growth in the number of insured and the physicians per capita.
Our previous analysis suggests that the trends in some access measures were different between those with private and public coverage. Therefore we run separate regressions for those with Medicaid and employer-sponsored insurance (ESI). The providers who serve Medicaid beneficiaries may serve very few people with ESI, and vice versa. Therefore, as a sensitivity analysis of access for adults with Medicaid, we re-estimate the regression with growth in Medicaid enrollment (as measured in administrative data) as the independent variable.