Thanks to the Affordable Care Act (ACA), millions more Americans are insured. However, that does not mean all these new customers can access healthcare without any trouble.

If someone bought an individual plan or if someone is on Medicaid, they encounter more barriers to care than those who are on employer-sponsored health insurance plans, according to the authors of a recent study.1

“The ACA introduced many policy changes that we didn’t adequately understand the impact of at the time of our study,” notes Héctor E. Alcalá, PhD, MPH, CPH, one of the study’s authors.

In particular, the researchers wanted to know if lower Medicaid reimbursement rates would be associated with poor access to providers. Further, Alcalá and colleagues set out to understand if the ACA insurance exchange offerings differed from other non-exchange insurance options in terms of access to healthcare.

“I was somewhat surprised that those with health insurance purchased through Covered California [that state’s ACA exchange] had a harder time getting their insurance accepted by a primary care provider than those with insurance purchased [outside the] exchange,” says Alcalá, an assistant professor in the department of family, population, and preventive medicine at Stony Brook (NY) University.

Researchers calculated the odds of being unable to access primary care doctors and specialists and schedule a needed appointment in a timely manner, using data from the 2014 and 2015 California Health Interview Survey. People on Medicaid or those who bought plans on the individual market struggled more in this area compared with people on employer-based coverage. Prior research has suggested there is no difference in the quality of care offered between exchange and off-exchange plans. However, no one had examined differences in access to care.

“Our study suggests that the barrier experienced by people purchasing their insurance coverage through Covered California is that primary care providers are less likely to accept their insurance, relative to other insurance coverage options,” Alcalá says.

It is unclear what this finding means for hospitals. If Covered California options translate to poorer access to primary care, it may benefit hospitals and other practices to become part of the networks in Covered California. Currently, the Covered California networks are smaller than off-exchange networks. “This potentially leaves patients with fewer providers that are willing to take their insurance coverage,” Alcalá says.

Hospitals can offer financial counseling to help people understand what all this means. “But if providers are unwilling to take [patients’] health insurance coverage, this is unlikely to help those who are unable to pay for care out of pocket,” Alcalá notes.


  1. Alcalá HE, Roby DH, Grande DT, et al. Insurance type and access to health care providers and appointments under the Affordable Care Act. Med Care 2018;56:186-192.