It’s Too Early to Tell

Apparently, there has been no measurable increase in the number of new sick patients as a result of the PPACA

In our previous report, we saw that, at least for the first quarter, a national sample of 12,700 physicians across the athenahealth network did not see an increase in new patients[1] due to the ACA. While not all new patients are newly insured, an increase in this population would suggest that coverage expansion is having an impact on medical practices. Instead, the percentage of total provider visits with new patients actually dropped slightly in the first three months of 2014 compared to 2013. Several factors may help explain why the ACA’s coverage expansion has not led to an immediate and measurable impact:

  1. The number of newly insured patients in the first quarter of 2014 may have been too small to have a measurable impact.
  2. Not all newly insured patients required care.
  3. It may require weeks or months for patients to schedule appointments and be seen.
  4. Our data suggests the influence of new patients on provider activity may take considerable time to unfold. Figure 1 shows the percentage of visits by new patients to Primary Care Providers (PCPs) at practice locations active before 2011. New patients account for 15% to 20% of office visits in the beginning of the year, growing as a proportion throughout the year. Note that a patient defined as new at any point during 2014 remains classified as new throughout the entire calendar year. In other words, these new patients are tracked as a cohort as the year progresses. We chose this definition to measure the level of effort physicians place in treating patients that are new to the practice across the year.

That’s a mixed bag. On the one hand it suggests that the new load on the healthcare system may be bearable but on the other it undercuts the argument in favor of the PPACA. The PPACA may have been the easiest thing for the Democratic Congress of 2009 to enact but it may not have been the reform that was needed. As to whether it will be sustainable, it’s just too early to tell.

The linked post is interesting in general and worth reading in full.

9 comments… add one
  • Guarneri

    Yes, with usage basically flat, and I’ve still not found convincing (not double counting/reupping flimsy) accounting figures north of 3 real new million signups, the marketing campaign of 30 million, no wait, 50 million……uninsured and most assuredly almost dead people as the rationale seems to have definitively gone the way of all such schemes and therefore this: The PPACA may have been the easiest thing for the Democratic Congress of 2009 to enact but it may not have been the reform that was needed…………appears spot on. And at such cost.


  • michael reynolds


    Too soon to mean anything one way or the other.


    So, if this means anything (and I don’t think it does) then zero of the terrifying tales of disaster you’ve foretold have actually occurred. Which you somehow interpret to mean that you were right all along.

    Intellectual rigor and honesty not really your thing, is it?

  • jan

    “The proportion of visits by new patients in the first quarter actually dropped slightly between 2013 and 2014.”

    There has been so much confusion, delays, misinformation about the PPACA. People signing up have been subject to pure frustration, oftentimes capped off by disappointment, when their premiums are finally sorted out to somewhat mirror their former HC coverage.

    An acupuncture friend of mine started working on her coverage, though the CA web site, last November. She spend untold hours trying to first weed through the web site, finally resorting to phoning in for help, only to find her best bet was paying twice the amount she used to pay, which included coverage for subscription drugs, which she didn’t want. In the meantime she hasn’t used any medical services. The same goes for a friend’s daughter, my son’s age, who applied for Obamacare right away, and only received a medical card a few weeks ago.

    I think when you combine the difficulty in navigating the government system, understanding one’s options, lag times in processing enrollments, some seeing huge deductibles, others coming to grips with narrowed provider networks, it may have discouraged people from seeking health care. Maybe, that’s the secret cost-cutting ingredient in the PPACA — creating a method so unappealing and ghastly that people lean away from using it, unless they absolutely have to.

  • michael reynolds


    Your friend is either fictional or not very bright. I’ve been on the Covered California site and had no confusion at all – certainly not compared to my efforts a few years ago to get a straight answer form a human insurance broker. If you can use Expedia you can use Covered California.

  • steve

    This early, I would not expect to see much different with PCPs. As noted by a commenter, I would monitor specialists early.


  • jan


    Why do you either dismiss or ridicule people and/or statements that disagree with your own premises?

    My ‘friend’ is an accomplished, savvy Asian woman, having coordinated dozens of acupuncture schools around the U.S for accreditation purposes. She is a mixture of brilliant and wise, and her estimation of Covered California was that the web site was ‘below par,’ not operational-friendly, and the premium, resulting from PPACA calculations and mandates, was far higher than what she was paying prior to her policy being canceled.

    Believe it or not, but the world according to Michael, can be experienced in a far different way for other people!

  • Guarneri

    It is working wonderfully, isn’t it?

    I’ll make a bet with you. I can hold down the premium/cost for anything………if I let other people subsidize it. As I said, at such a cost………and increasing. We should have just made millionaires out of the uninsured by cutting them a check instead of this Rube Goldberg monstrosity. BTW – I recall when the VA system was touted as a model of govt single pay in action. How’s that working out, or have you not heard? Don’t worry, Obama only found out the other day from TV while watching reruns of “Walker, Texas Ranger.” Jay Carney told me so……..

  • jan


    Obama seems to run his presidency under a rock, or under ground, where there is no intelligence available until he turns on the TV. Any other president, from any other era, would be ridiculed far more than Michael ridicules republicans, if they demonstrated such a ‘leadership’ pattern, time and time again.

    Even as Obama is finally commenting on the VA problems, his mind is probably more fixated on the fundraising functions ahead of him. That’s what he does best, act as kind of the tinsel leader who raises money and is a great entertainer.

  • steve

    The problem with the VA is trying to determine who is eligible for care. This is actually pretty difficult a good deal of the time. The actual care provided is rated as pretty good.


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