Percentage of Ambulatory Primary and Preventive Care Visits Stratified by Insurance Group and ACA Period
| Continuously Uninsureda (n = 28,834) | Gained Medicaidb (n = 20,766) | Gained Other Insurancec (n = 17,171) | No Post-ACA Period Ambulatory Care Visitsd (n = 71,475) | |
|---|---|---|---|---|
| Overall ambulatory care visit rates per patient per period | ||||
| Pre-ACA period, rate | 4.64 | 4.57 | 5.47 | 2.18 |
| Post-ACA period, rate | 4.00 | 6.29 | 7.59 | … |
| Pre/post rate change | −0.64Ref | 1.72e | 2.12e | … |
| Overall ambulatory care visits, No. (%) | ||||
| Pre-ACA period | ||||
| 0 | … | … | … | … |
| 1-2 | 12,150 (42.1) | 9,579 (46.1) | 6,603 (38.5) | 54,450 (76.2) |
| 3-5 | 8,998 (31.2) | 6,123 (29.5) | 5,030 (29.3) | 12,462 (17.4) |
| ≥6 | 7,686 (26.7) | 5,064 (24.4) | 5,538 (32.3) | 4,563 (6.4) |
| Post-ACA period | ||||
| 0 | … | … | … | … |
| 1-2 | 14,298 (49.6) | 7,009 (33.8) | 3,177 (18.5) | … |
| 3-5 | 8,195 (28.4) | 6,180 (29.8) | 5,475 (31.9) | … |
| ≥6 | 6,341 (22.0) | 7,577 (36.5) | 8,519 (49.6) | … |
| Primary care visits, No. (%) | ||||
| Pre-ACA period | ||||
| 0 | 2,310 (8.0) | 901 (4.3) | 975 (5.7) | 12,631 (17.7) |
| 1-2 | 12,406 (43.0) | 9,681 (46.6) | 6,646 (38.7) | 45,693 (63.9) |
| 3-5 | 8,722 (30.2) | 6,153 (29.6) | 5,232 (30.5) | 10,144 (14.2) |
| ≥6 | 5,396 (18.7) | 4,031 (19.4) | 4,318 (25.1) | 3,007 (4.2) |
| Post-ACA period | ||||
| 0 | 2,595 (9.0) | 462 (2.2) | 364 (2.1) | … |
| 1-2 | 14,210 (49.3) | 7,297 (35.1) | 3,858 (22.5) | … |
| 3-5 | 7,758 (26.9) | 6,393 (30.8) | 5,989 (34.9) | … |
| ≥6 | 4,271 (14.8) | 6,614 (31.9) | 6,960 (40.5) | … |
| Preventive care visits, No. (%) | ||||
| Pre-ACA period | ||||
| 0 | 24,228 (84.0) | 18,508 (89.1) | 14,696 (85.6) | 66,499 (93.0) |
| 1-2 | 4,590 (15.9) | 2,254 (10.9) | 2,465 (14.4) | 4,971 (7.0) |
| 3-5 | 16 (0.1) | 4 (0) | 10 (0.1) | 5 (0) |
| Post-ACA period | ||||
| 0 | 24,839 (86.1) | 16,942 (81.6) | 12,883 (75.0) | … |
| 1-2 | 3,971 (13.8) | 3,792 (18.3) | 4,232 (24.6) | … |
| 3-5 | 24 (0.1) | 32 (0.2) | 56 (0.3) | … |
ACA = Patient Protection and Affordable Care Act; Ref = reference group.
Notes: Pre-ACA = January 1, 2012 to December 31, 2013; Post-ACA = January 1, 2014 to December 31, 2015.
Visits refer to ambulatory care only.
Overall ambulatory care use includes all billable encounters. Primary care Current Procedural Terminology codes: 99201-99205, 99212-99215, 99241-99245, 99381-99387, 99391-99397. Preventive care Current Procedural Terminology codes: 99385-99387, 99395-99397.
Pairwise insurance-group differences between Continuously Uninsured vs Gained Medicaid, Continuously Uninsured vs Gained Other Insurance, and Continuously Uninsured vs No Post-ACA Period Ambulatory Care Visits were statistically significant for overall, primary care, and preventive care visits (P <.05).
↵a All preperiod visits were uninsured, and all postperiod visits were uninsured.
↵b All preperiod visits were uninsured, and all postperiod visits were covered by Medicaid with the following exception: to allow for time to enroll in Medicaid, the first visit post-ACA could be uninsured.
↵c All preperiod visits were uninsured, and during the post-ACA period, visits were covered by other insurance types or insurance patterns (churning).
↵d All preperiod visits were uninsured, and there were no visits during the post-ACA period.
↵e Statistically significant (P < .05) interaction terms between insurance groups by time period using a Poisson regression model.