Access to Care Report (#13) / Access may be tracked after opening day for ACA exchanges

October 3, 2013


This is #13 in a series of Access to Care Reports. (See also postings by Mitchell Law Office)

Sales of insurance policies through Health Exchanges and enrollment in expanded Medicaid programs (in some states) are both scheduled for start-up on October 1. The actual impact of improved funding on increased access to health care services can then start to be tracked as of January 1, 2014.

Evaluations of improvements in access may take place from many points of view.

Access can be measured by the numbers of individuals who successfully purchase insurance policies, and the numbers of small businesses that elect to set up group policies.

It can also be measured by the numbers of individuals enrolling in expanded Medicaid.

Access can be evaluated in terms of attitudes toward the sign-up process. Surveys of individuals and small businesses can indicate “how the process went” for them, and determine feelings about participation. Access will be improved where personal reactions to the process are favorable.

Access can further be measured by how individual and employer experiences affect the overall “branding” of the Affordable Care Act (ACA) among members of the public at large. If individual experiences are favorable, support for the ACA will likely begin to increase. Public reactions to the Plan and readiness to participate are both likely to improve. Access will then be linked to both individual experiences and public-at-large attitudes.

If individual experiences are unfavorable, these experiences are likely to create negative reactions among the public at large.

Access to care will be linked to how employers, insurance companies, and providers respond to initial operational activities by the Exchanges. Whether or not individuals choose to participate—and then seek out care—will be shaped by the messages received from these organizations.

Thus, access will be driven by many factors, including the sign-up numbers; attitudes toward the sign-up experience; media messages; and messages from health care organizations. These factors will combine to help shape the willingness of individuals to seek services.

In the near future, access will also begin to be strongly affected by service experiences. If individuals find that care arrangements under the new insurance policies, and under Medicaid, are satisfactory, they will be willing to seek out a broader range of services that may have a positive impact on health status.

On the other hand, if care experiences are unsatisfactory, or if copayments and deductibles are seen as too large, or if the personal costs of seeking out care are too high, individuals may cut back on the care services that they seek. Thus, access depends on the experiences at all stages of implementation.

As individual experiences are gained, these insights will be merged and filtered through communications; sampled; and written about in the media. Access through the ACA will be shaped and reshaped.

Attorneys can observe this process, in order to better evaluate client participation in the ACA, and to provide appropriate advice to clients regarding new options for access to care.

More on  related ACA and access to care topics may be found in a recent book by the authors that describes implementation of the ACA, and in a new Practice Guide by the authors that addresses funding and access issues in health care.

Previous installments of “Access to Care Reports” address the various ways in which access to care issues are affecting legal practices:

Report #1   Report #2   Report #3   Report #4   Report #5   Report #6   Report #7   Report #8   Report #9   Report #10   Report #11   Report #12