New Study Examines Patient Payment and the Affordable Care Act

According to a new study from the UCLA Center for Health Policy Research, the Affordable Care Act (ACA) has not impacted federal Community Health Centers (CHCs) in the way that experts initially predicted, with CHCs seeing more patients, many of whom remain uninsured.

CHCs generally exist to help those in disadvantaged communities, such as people who are not eligible for Medicaid or coverage via the health insurance exchange. Before the ACA was signed into law in 2010, the law was expected to cause newly-insured patients to stop using CHCs and go elsewhere for their care.

This study of 31 CHCs from California, Georgia, New York, and Texas shows that CHCs are seeing over 30% more patients now than before the ACA was passed. Many of the patients still using CHCs lack health insurance and need to self-pay.

Two of the states studied expanded Medicaid (California and New York) while the other two did not (Georgia and Texas). That didn’t seem to make a big difference regarding the number of patients who visited CHCs. California and Texas both saw CHC patient increases of more than 40%, while New York and Georgia saw slightly more moderate increases.

The area where Medicaid expansion has a noticeable impact is in the number of uninsured patients visiting CHCs, who then need to self-pay. The states that didn’t expand Medicaid - Georgia and Texas - saw an increase in the number of uninsured patients visiting CHCs. The states that did expand Medicaid - California and New York - both saw a decrease in the number of uninsured patients.

Even among patients that gained insurance after the passage of the ACA, many of them had high-deductible health plans (HDHPs) that make patients need to self-pay for at least part of their care. Some patients are more able to do this than others, and providing uncompensated care is an ongoing issue for CHCs.

insideARM Perspective

This UCLA study shows how revenue cycle management and the relationship between patients and their bills are changing due to the ACA and the increased prevalence of HDHPs.

There are several recommendations for health care providers in the study relating to payment for healthcare. They are as follows:

• Find “the optimal balance of payer mix and services” depending on the needs in a particular locality.
• Expand Medicaid in all states to ensure “more stable revenue streams.”
• Providers should “move away from traditional volume-based reimbursement” and focus on “moving toward alternative payment models that require accountability” over time.

Also, be sure to read insideARM's recent coverage on improving your revenue cycle processes, self-pay research, and relevant legislation currently under consideration.