News & Commentary

Uninsured Struggle To Obtain PCP Care


More people are insured thanks to the ACA, but for those who are not, getting an appointment with a primary care physician (PCP) can be problematic, according to a study published in the April issue of Health Affairs that examines access to PCPs for the uninsured.

The authors noted that there was a temporary lapse in funding for the centers until Congress approved a two-year extension for the Community Health Center Fund as part of the Bipartisan Budget Act of 2018.

“Sustaining investments in safety net settings, and federally qualified health centers in particular, could help ensure that the uninsured have access to basic primary care,” the study stated.

But even with the extension of funding, the centers don’t represent a comprehensive solution to the problem of access because they may be inaccessible to those who live outside of medically underserved areas where the health centers are usually located.

To gather the data, researchers had people who portrayed themselves as uninsured patients calling PCP offices seeking appointments and information on the cost of care and payment arrangements. The calls were made in 2012 and 2013, and then again in 2016.

And about 80% of callers got those appointments—provided they could pay in cash for the visit. (They paid $164 in 2012–2013 and $163 in 2016.)

Things changed if the callers tried to make a deal, the study stated. It said that “fewer than one in seven callers in both time periods received appointments for which they could make a payment arrangement to bring less than the full amount to the visit.”

Lead author Brendan Saloner of the Johns Hopkins Bloomberg School of Public Health told Reuters: “We know that access to care has improved for people who got health insurance under the ACA. But we took a unique perspective with this study and looked at the population who still have no insurance—whether by choice or as a result of ineligibility.”

The study was conducted in Arkansas, Georgia, Illinois, Iowa, Massachusetts, Montana, New Jersey, Oregon, Pennsylvania, and Texas.

In 2012–2013, 78.8% of the callers were able to get a PCP appointment if they said that they could pay the full price at the time of the visit. (The scheduled appointments were canceled either at the end of the phone call or soon after.) The rate went up a bit in 2016 to 80.5%.

The percentage that could get an appointment that included paying for the visit in installments was 14% in 2012–2013 and 11.9% in 2016.

“Among callers offered a payment arrangement, the agreed-upon price was 52.9% of the full price in 2012–2013 and 45.8% in 2016, a difference that was significant,” the study stated. “That indicates that a smaller fraction was required in 2016 than in 2012–2013 among the small subset of callers getting a payment arrangement.”