A wide range of charges
The Affordable Care Act mandates that some types of preventive care cost nothing for patients with insurance. But physicians are free to make their own decisions about how much to charge uninsured patients who pay out of pocket for all types of visits. As part of ACAView, our ongoing project to assess the impact of the Affordable Care Act on the healthcare delivery system, we analyzed how much those uninsured people actually pay for primary care.
Our analysis is based on visits from 400,000 uninsured adult patients to 19,000 primary care physicians on the athenahealth network in 2015. We measured payments either during the visit or after, including payments through July of 2016.
This is the first time, to our knowledge, that actual patient payments for uninsured patients have been measured; other studies have looked what practices report that they would charge uninsured patients, but do not measure what these patients actually pay.
The implications of free and low-cost primary care
It's possible that some proportion of these people can't access insurance at all, either because they're undocumented immigrants who aren't eligible for Medicaid, or because they're poor and live in non-expansion states — and thus can't qualify for either Medicaid or subsidies on healthcare exchanges.
Still, it's clear that many uninsured patients qualify for Medicaid and other subsidies, or could afford unsubsidized commercial coverage. And if those patients believe they're unlikely to need specialty, emergency, or hospital care, then the availability of free or low-cost primary care might make them feel more comfortable remaining uninsured — and thus less likely to get routine or preventive care, with potential consequences for their health and financial well-being.
Physicians can play a key role here in counteracting this tendency, by taking the time to stress the health benefits of remaining insured even if primary care is easily available.
Analysis for this report was performed by Anna Zink. Photography by David McLain.