Impact of changes in Medicaid coverage on physician provision of safety net care

The Patient Protection and Affordable Care Act will expand Medicaid coverage substantially, with the goal of improving the health of low-income individuals and reducing disparities in coverage and access. Whether insurance expansions are successful in achieving this goal will depend in part on physician response to changes in insurance coverage mix and the effect of this response on access to care for low-income safety net populations.

The objective of the study was to consider the impact of changes in market-level Medicaid coverage on measures of physician participation in care for safety net populations.

We use 4 waves of the Community Tracking Study Physician Survey from 1996 to 2005. We estimate both market-level and physician-level fixed effects models, to consider changes in market-level Medicaid rates on measures of physician acceptance of new patients (both Medicaid patients and uninsured patients unable to pay), revenue from Medicaid, and provision of charity care. We also stratify the sample to investigate whether effects differ among office-based versus facility-based physicians.

Increases in Medicaid coverage are associated with statistically significant decreases in the likelihood that physicians will accept new uninsured patients who are unable to pay, particularly among office-based physicians. Increases in Medicaid coverage are not associated with changes in acceptance of new Medicaid patients.

Past changes in Medicaid coverage rates are not associated with changes in physician acceptance of new Medicaid patients or provision of charity care, although they are associated with lower acceptance of new uninsured patients, particularly among office-based physicians.