If there was one issue that shaped the narrative of health insurance reform under the Affordable Care Act the most, it was that of individual patient coverage: who would get to keep theirs, who would lose theirs, and who would switch.
As we inch closer to another election cycle – one in which healthcare reform is again a high-level campaign issue – that concern is coming back into focus. But with the first few years of ‘Obamacare’ behind us, we finally have some numbers to help us assess the ACA’s impact on patient behavior when it comes to insurance.
As you’ll no doubt remember, the biggest ‘coverage controversy’ surrounding President Obama’s modification of the American health insurance system was his much-touted campaign promise: “If you like your healthcare plan, you can keep your healthcare plan.” When 4 million people received cancellation letters following the implementation of the ACA, it became clear the President’s soundbite wasn’t as true in practice as the public had hoped.
Hospitals and medical practices recovered well from that initial crisis. But the breadth and depth of healthcare-exchange options and the year-end rate hikes on many ACA plans led to widespread worry about patients changing their coverage plans and, resultingly, abandoning their providers or discontinuing care.
And this is where there’s good news to report: Fears over insurance switching were, mostly, unfounded. According to new research from the ACAView initiative, patient insurance switching has increased since 2013, but at a minimal-to-modest rate.
The strongest trend has been a positive one: more Americans are now insured. The biggest changes have been in Medicaid expansion states, where over 40% of uninsured patients obtained insurance the following year in both 2014 and 2015. (In comparison, in non-Medicaid expansion states, about 25% of previously uninsured patients obtained insurance during the same time periods.)
As for other insured patients, there has been only a slight uptick in plan swapping. The percentage of commercially insured patients who have switched coverage in the subsequent year has increased from 15.0% pre-ACA expansion to 18.3% in 2014 and 17.3% in 2015. This may be occurring because some commercially insured patients switch to plans on the health insurance marketplaces because they are eligible for subsidies.
One other interesting finding from the research is that in Medicaid expansion states, the proportion of commercially insured patients who switch to Medicaid coverage – though rare – has doubled. In 2014, 1.2% of commercially insured patients in continuous care switched to Medicaid coverage. Prior to coverage expansion, only 0.6% switched to Medicaid coverage in the subsequent year. (In 2015, this proportion increased to 1.6%.)
Ultimately, the ACAView research shows that while insurance-switching hardly constitutes a troubling trend to practice management, it’s a development for medical practices to keep an eye on. Notably though, the switching behavior of people who changed plans or payers had no significant impact on their utilization of coverage.
According to ACAView’s data there were no clear changes in either visit frequency or relative value units (RVUs) per visit whether patients switched commercial insurance plans with the same payer, or switched payers altogether. And in the end, that’s the most important thing; American patients are still getting care the care they need, and medical practices are keep their revenue cycle management bottom lines on track as a result.