A Look Under the Hood: Regulatory Policy Making and the Affordable Care Act

Potemkin Protections: Assessing Provider Directory Accuracy and Timely Access for Four Specialties in California

CONTEXT

The accuracy of provider directories and whether consumers can schedule timely appointments are crucial determinants of health access and outcomes.

METHODS

We evaluated accuracy and timely access data obtained from the California Department of Managed Health Care, consisting of responses to large, random, representative surveys of primary care providers, cardiologists, endocrinologists, and gastroenterologists for 2018 and 2019 for all managed care plans in California.

FINDINGS

Surveys were able to verify provider directory entries for the four specialties for 59% to 76% of listings or 78% to 88% of providers reached. We found that consumers were able to schedule urgent care appointments for 28% to 54% of listings or 44% to 72% of accurately listed providers. For general care appointments, the percentages ranged from 35% to 64% of listed providers or 51% to 87% of accurately listed providers. Differences across markets related to accuracy were generally small. Medi-Cal plans outperformed other markets with regard to timely access. Primary care consistently outperformed all other specialties. Timely access rates were higher for general appointments than for urgent care appointments.

CONCLUSIONS

Our finding raise questions about the regulatory regime as well as consumer access and health outcomes.

Past experiences with surprise medical bills drive issue knowledge, concern and attitudes toward federal policy intervention

Scholars and journalists have devoted considerable attention to understanding the circumstances in which Americans receive surprise medical bills. Previous research on this issue has focused on the scope of the problem, including the conditions that are most likely to lead to surprise bills. However, the existing literature has almost exclusively relied on claims data, limiting our understanding of consumer experiences and attitudes toward policy changes to address surprise billing. Using a survey administered to a nationally representative sample of 4998 Americans, we analyze consumer experiences with surprise billing, knowledge of the issue, how concerned Americans are about receiving surprise bills and how past experiences influence policy preferences toward federal action on surprise billing. Our analysis demonstrates that knowledge and concern about surprise billing are the highest among the educated and those who have previously received a surprise bill. These factors also predict support for federal policy action, with high levels of support for federal policy action across the population, including among both liberals and conservatives. However, more detailed federal policy proposals receive significantly less support among Americans, suggesting that stand-alone policy action may not be viable. Our results show bipartisan support among American consumers for federal action on surprise billing in the abstract but no consistent views on specific policy proposals.

Lingering Legacies: Public Attitudes about Medicaid Beneficiaries and Work Requirements

CONTEXT

This article provides a detailed picture of the mindset of Americans about Medicaid work requirements and the important roles that perception of deservingness and racial bias play in public attitudes.

METHODS

The authors conducted a large original survey to investigate public attitudes toward work requirements. They analyzed the predictors of overall support for work requirements, correlates of who should be exempt from them, and attitudes toward work supports that make compliance with work requirements easier.

FINDINGS

The authors found that public opinion is split relatively evenly when it comes to Medicaid work requirements in the abstract. When Americans are confronted with the complexities of the issue, important nuances emerge. The authors also found consistent evidence that support for work requirements is higher among conservatives, those who see Medicaid as a short-term program, and racially resentful non-Hispanic whites. They show that groups that have historically been framed as deserving see high levels of support for their exemption (e.g., the disabled and senior citizens). Finally, the authors found that Americans are supportive of policies that provide individuals with help when transitioning into the workforce.

CONCLUSIONS

Americans' views of Medicaid and the populations it serves are complex and continue to be influenced by perceptions of deservingness and race.