The Ecology of Medical Care Before and After the Affordable Care Act: Trends From 2002 to 2016

Johansen and Richardson and their team present a lot of work in this article that provides insight not just about the implementation of the ACA, but trends in how people in the US have participated in health care since the beginning of the 21st century. MEPS allows such analyses and remains an important health services research asset. The description of these patterns continues to be provocative, inspiring a host of questions through the quantification of where individuals of all ages and walks of life get care. It constitutes basic science research for those who research health care.

The general stability of participation despite substantial disruptions and changes in US health care during the period analyzed is, again, striking, suggesting that the needs and demands of people persist during periods of change and transformation-an important and humbling revelation. The decline in visits to physicians, especially after the substantial drop in uninsured people, surprised me and is important "news" in these analyses. What does this persistent trend of people in the US getting less health care from physicians mean? What is its relationship to physician burnout, virtual care, changing purposes of physicians, workforce composition and balance? Is this decrease a desirable trend? What is a nurse, a physician these days and down the road a few years? Is getting dental services occurring as it should? What is planned and underway for MEPS categories of service types-to capture digital care, behavioral health care, evolving public health services-in various emerging forms?

This report is a jewel inviting exploitation by investigators and continued monitoring so we can know where people are actually obtaining care as we pursue the quadruple aim and the most substantial redesign of health care in a century. Many thanks.

Competing interests: None declared