Welcome to Health Reform Watch, Jason Millman's regular look at how the Affordable Care Act is changing the American health-care system — and being changed by it. You can reach Jason with questions, comments and suggestions here. Check back every Monday, Wednesday and Friday afternoon for the latest edition, or sign up here to receive it straight from your inbox. Read previous columns here.

It's pretty clear that the uninsured rate has dropped since Obamacare's coverage expansion took effect, though there are still questions about by how much and where new coverage is coming from. Just as importantly, though, there are questions about how people are using their new coverage.

We still don't have a clear answer on that yet, but some new data this week suggests that primary care doctors haven't been overly burdened with newly insured patients since Affordable Care Act coverage took effect in January.

Athenahealth, which provides electronic health records and online practice management software to doctors, has some interesting perspective on what primary care providers have experienced in the ACA's first few months. Working with the Robert Wood Johnson Foundation, Athenahealth has been analyzing data from the 12,700 doctors in its network.

Their data show that proportion of new patient visits actually dropped slightly in the first three months of this year compared to the same period in 2013. Athenahealth offers three possible explanations for this:

  • The number of newly insured patients in the first quarter of 2014 may have been pretty small;
  • the newly insured patients may be relatively healthy;
  • and it could take weeks or months for the newly insured to get an appointment.

On the first point, Athenahealth says past data show the proportion of newly insured patients tends to grow during the year. On the second point, Athenahealth's records show that the chronic disease rate for new patients in 2014 are pretty similar to the same period in 2013. And new patients have lower chronic disease rates than established patients, which is an especially important metric, given concerns about the health status of new Obamacare enrollees.


Given all the focus on the health-care law's narrow networks and the reluctance of some doctors to accept new Medicaid patients, another concern is whether the newly insured are actually able to find doctors who will see them. New data from California's Obamacare exchange indicate there's been some early frustration in this area. Of the 1,500 formal complaints about exchange coverage between January and April, 12 percent cited issues accessing care, the Los Angeles Times reported Friday. The California numbers, though, likely include previously insured customers who purchased exchange health plans.

Before the ACA, low-income patients also often sought out primary care in the emergency room, which is a more expensive care setting. ER doctors, in a survey they issued this week, said they expect ER visits to increase as the law is implemented. And previous research out of Oregon shows that expanding Medicaid actually increased ER visits.

The Urban Institute, in research posted Thursday, suggests it may take some time before the newly insured get acclimated with the primary care system.

"Helping the newly insured form connections with primary care providers and obtain the care that they need in the appropriate settings is the next step in moving from coverage to care," Urban wrote. "Making that transition may be difficult as the newly insured, particularly the newly insured who have not had health insurance before, may need help learning how to access care through their coverage."

Top health policy reads from around the Web:

Health care job growth has slowed. "Health care hiring continues, but it’s rising this year at a stubbornly slow annual rate of 1.4 percent, hit by a sluggish economic recovery, mandatory cuts in government spending and streamlining required by the Affordable Care Act. ... Some analysts say it’s partly a side effect of the [ACA] which aims to penalize inefficiency and waste. It also intends to slow rising health care costs, which were accounting for a greater share of the nation’s economy every year." Kevin G. Hall in McClatchy.

Why people skipped Obamacare coverage. "About half of uninsured Americans surveyed didn’t try to sign up for health coverage under Obamacare because they said they couldn’t afford it, with most unaware that financial assistance was available. Cost also was the main reason given by 39 percent of people who looked for insurance and decided against it, according to a survey of 1,524 people by Enroll America ... Only 26 percent of those who didn’t enroll were aware that there were government subsidies available." Bruce Rule in Bloomberg.

The NRA blocks Surgeon General pick. "The White House’s pick to serve as the nation’s top doctor has been stalled since February because the National Rifle Association opposes him. ... [T]he NRA, as well as some Republicans, say past Murthy statements in support of gun control indicate that he could use the surgeon general job to promote anti-gun policies. Murthy has stated that he would not focus on gun violence in the position." Jennifer Haberkorn in Politico.