Obamacare boost to doctors’ fees expanded access for low-income patients

When the government expanded Medicaid under the Affordable Care Act, lawmakers wanted to be sure there would be enough primary care doctors to treat the surge of new patients, so they boosted reimbursement rates.

Two years later, that logic remained untested. Now, findings from the University of Pennsylvania suggest that economic nudge was successful.

In the study, secret shoppers posed as patients with either private or Medicaid insurance and called doctor’s offices in 10 states. Initially, Medicaid callers were granted an appointment about 58 percent of the time. But once fees were raised to match the more generous rates of Medicare, physicians were about 8 percentage points more likely to accept a Medicaid patient.

“When I first saw that number, my jaw dropped,” said Daniel Polsky, executive director of the Leonard Davis Institute of Health Economics at Penn, and lead author of the new study. “It’s a very large effect, especially for such a short time period.”

The team found that for every 10 percent increase in Medicaid payments, appointment availability increased 1.25 percent. Wait times, regardless of the type of insurance, were not affected. The results were published Wednesday in the New England Journal of Medicine.

While the fee hike may have worked, it came with a price tag of $12 billion, and expired at the end of 2014. In New Jersey and Pennsylvania, the Medicaid payments primary care doctors now get are about half of what they were a month ago.

“Policymakers like to have evidence when they make decisions about how to spend money, so now they have evidence that this policy works,” said Polsky. “Hopefully that will inform reasonable discussions about whether to continue with the pay bump.”

Some states, including Delaware, have already decided to extend the higher rate.

Taunya English contributed to this report.