People aren’t just better insured under the Affordable Care Act (ACA); they also feel better since it went into effect.
Those findings were published earlier this year in the Journal of the American Medical Association (JAMA). However, an article from last month shows that there are still worries in the insurance marketplace for consumers.
Nearly 12 million people have enrolled in plans through the ACA’s marketplace since its inception and the U.S. Department of Health and Human Services, which regulates those plans, applies a standard of “reasonable access” to “a sufficient number and type of providers."
“There’s coverage available and people who are signing up for it who were uninsured are finding that they are definitely better able to access the care they need and afford it,” Dr. Benjamin Sommers, author of both JAMA studies, told Patient Daily. “That said, people need to be careful shoppers.”
Across all metrics surveyed, including access to primary care physicians, overall health status and coverage, the introduction of the ACA reversed the downward direction of respondent’s experiences. People’s health has improved along with their access and coverage.
Approximately 15 percent of plans included in Sommer’s study of the federal marketplace had no specialty physicians (i.e., endocrinologists, psychiatrists or rheumatologists) within 100 miles. This could be potentially very costly for patients enrolled in these plans because no specialist would be in-network.
The study did not determine an overall cause for the high number of plans without access to in-network experts but posed several theories, including having specialists but not communicating the proper list to patients, specialists leaving a coverage network or an attempt to curtail costs by discouraging patients who may need to frequently see specialists from taking such a plan.
“They need to look at the different plans, figure out if they have the providers they want and also make sure they’re getting the level of benefits in terms of how extensive it’s going to be and how much cost-sharing there’ll be to make sure they’ll get what’s best for them,” Sommers said. “If you’re not careful, you might end up in a plan that doesn’t meet your needs well.”
Despite the need to make sure an insurance plan is suited for the consumer, the general consensus of the studies are that the ACA has been a resoundingly positive force for consumers: seven million more adults have a primary physician, five million more report better access to benefits since the ACA’s first enrollment and more than 10 million Americans reported being better able to afford their care.
“Even though overall what we’re seeing with the Affordable Care Act is that it is helping people, you want to make sure you get the best plan for you,” Sommers said.