Background: Millions of Americans have purchased insurance coverage through health insurance exchanges (HIX) created by the Affordable Care Act, but it is unknown whether these patients are facing barriers to care such as restricted networks or
limited appointment availability.
Methods: We performed an office survey and an audit study of thousands of primary care offices across 10 states. First, we estimated the in-network rate, defined as the share of offices that participated in at least one network for a given insurance
type (HIX plans, employer-sponsored insurance (ESI), or Medicaid). Second, we estimated the appointment availability rate, defined as the share of in-network offices that successfully scheduled an appointment with a simulated new patient randomized to a given
insurance type (HIX, ESI, or Medicaid).
Results: We found that patients enrolled in HIX plans had an intermediate degree of difficulty in accessing in-network primary care physicians and scheduling appointments. Among primary care offices accepting ESI, 91% also participated in a network
for at least one HIX plan and 75% participated in a network for at least one Medicaid plan. Similarly, the appointment availability rate was 73% for HIX plans compared to 83% for ESI and 63% for Medicaid. These patterns were consistent across nearly all states.
Conclusions: The scope of primary care physician participation in HIX plans was wider than in Medicaid, but narrower than in ESI. These results provide insight into some of the challenges HIX patients face and can better inform policymakers about
the trade-offs involved in increasing coverage.