ACA increased primary care utilization but risky behaviors also went up, study shows

One of the goals of the Affordable Care Act (ACA) that was enacted in March of 2010 was to provide access to quality healthcare to more people. The idea, generally, was to improve the health outcomes for patients at a lower cost to them. Patients with quality, low-cost healthcare should be more inclined to seek out preventative care. That, in fact, has proven to be the case, according to a recent study conducted by the National Bureau of Economic Research (NBER).

The NBER examined patient behavior three years after the law had taken effect. Their study used “data from the Behavioral Risk Factor Surveillance System and an identification strategy that leverages variation in pre-ACA uninsured rates and state Medicaid expansion decisions.” That research found that preventive care did indeed increase, but so did the risky behaviors of the people surveyed.

Primary care visits for preventive tests and immunizations increased in an “economically meaningful” way, according to the report. The study found that the “number of checkups rose by 3.8 percentage points, flu shots by 1.9, pap tests by 4.3, mammograms by 1.5 and HIV tests by 2.1.” These results “imply that between 17% and 50% of newly insured people increased preventive care.”

However, the study also found that the “likelihood that someone would become a risky drinker increased 1.6 percentage points. Smoking and exercise also showed signs of worsening, but not in a significant way.” The researchers posited that these types of risky behaviors may have increased because they are not directly related to the cost of healthcare. Patients do not tend to reduce their drinking or smoking habits, in particular, unless these activities begin to affect their health.

A further significant finding in the research conducted by NBER was that the use of primary care tended to increase among patients with private insurance and was not caused by the Medicaid expansion that occurred in many states as a result of the ACA. The researchers’ theory was that because Medicaid payments are much slower than private insurance, many patients may have actually had a difficult time finding a primary care physician.