When the Affordable Care Act was passed in 2010, an expanded version of Medicaid became possible for states across the country by adjusting income thresholds. Most states officially adopted and implemented these provisions in 2014; however, several states carried out early Medicaid expansion between 2010 and 2012. The Supreme Court declared expansion optional rather than mandatory in 2012 and currently, 12 states have elected to not expand their Medicaid programs. For those states that have expanded, more than 21 million individuals, including those with disabilities and children, gained health insurance coverage. This put strain and stress on the health care systems in expansion states. To quantify the impact, researchers at Harvard and Stanford explored whether physicians started accepting new Medicaid patients and measured the total number of physician visits during early expansion.

In a recently published study in HSR, Drs. Vilsa Curto and Monica Bhole used data collected by the Centers for Medicare and Medicaid Services to explore physician participation in six early expansion states (California, Connecticut, D.C., Minnesota, New Jersey, and Washington).

Using a broad sample of 1.2 million physicians, the authors looked at outpatient physician visits across primary care, obstetrics, pediatrics, and other specialties. They found that among physicians who had already been seeing Medicaid patients pre-expansion, the total number of visits increased by 29 percent. However, the expansion in these states did not bring in new physicians to offer services to Medicaid patients – meaning that the patient population expanded, but the number of available physicians did not.

Health care systems and private physicians who are considering but not currently accepting Medicaid insurance may need more education on the Medicaid system and how expansion affects their day-to-day operations. The authors suggest new policies enhancing access to care may need to target physicians who already accept Medicaid patients rather than focusing on those who don’t. Currently, 12 states, including Texas and Florida, have elected to not expand their states’ Medicaid programs. States that have not expanded Medicaid could use these results to engage physicians and health care systems in assessing the benefits of serving more patients.

Additionally, these results speak only to a small number of states that expanded their Medicaid programs early on during the Affordable Care Act’s implementation. More research is needed to understand how Medicaid expansion affects physician participation in states that expanded in 2014 or in states that recently adopted the provision, such as Idaho in 2020 and Oklahoma in 2021.

For more information on this study, please contact Vilsa Curto, T.H. Chan School of Public Health, Harvard University.

As part of our mission to advance evidence to inform policy and practice, AcademyHealth works with HSR, one of our official journals,  to develop and publish plain language summaries of selected articles from each issue. Articles are selected by HSR Editor-in-Chief Austin Frakt, Ph.D., and the summaries are prepared by AcademyHealth staff in partnership with article authors.

Committee Member, Member

Kaleigh Ligus, M.A.

Ph.D. Candidate - University of Connecticut

Kaleigh is a doctoral student in the Human Development and Family Sciences department at the University of Con... Read Bio

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