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The Obamacare Surge? No Sign of Pent-Up Doctor Demand Yet

Image: Murillo reads a leaflet at a health insurance enrollment event in Cudahy, California

Arminda Murillo, 54, reads a leaflet at a health insurance enrollment event in Cudahy, California. LUCY NICHOLSON / Reuters

Remember all those predictions that Obamacare was going to create a crush of pent-up medical demand? All these millions of newly insured people were not only going to pack doctors’ offices, but they were all going to be sick with all sorts of untreated illnesses like diabetes and clogged arteries?

That doesn’t seem to have happened, according to a new report.

In fact, visits appear to be down slightly over 2013, before 9 million people or more gained fresh insurance under the 2010 Affordable Care Act, the team at Athenahealth found.

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“Most specialty types did not see higher new patient visit rates for the first five months of 2014 than they did in the same period in 2013. Indeed, with the exception of pediatrics, all specialties are seeing lower new patient visit rates in 2014 compared to 2013,” they wrote.

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A second report out this week tries to get a handle on how much healthcare reform will cost the country, and projects it will cost $3.3 trillion over the next 10 years.

Athenahealth provides medical services, including cloud-based medical records. They analyzed direct data from 14,300 doctors who are clients, covering 5.8 million patients over 12.2 million visits. “I would say they are fairly representative” of the nation as a whole, said Katherine Hempstead of the Robert Wood Johnson Foundation, which commissioned the study.

“It’s consistent with other reports saying we are not seeing a huge surge in demand for care,” Hempstead added.

The Athenahealth team looked to see if maybe it varied state by state. Some states embraced Obamacare, building their own health insurance exchanges to help people buy insurance and also expanding the Medicaid program for low income people. Other fought it, doing as little as possible and not expanding Medicaid. But it didn’t seem to matter, the Athenahealth team found.

“It’s consistent with other reports saying we are not seeing a huge surge in demand for care."

And new patients didn’t seem to be any sicker, either.

“One important concern about the transition to coverage expansion was that some newly insured patients might seek care for illnesses that had previously been untreated,” the Athenahealth team wrote. "Physicians and other providers would then struggle to provide care to these sicker-than-average patients while continuing to meet the needs of their established patients.”

But when they looked at tests, diagnoses and other data from the doctor visits, the Athenahealth team found little evidence that people were coming in with, say, diabetes that had not been treated for years. In fact, the new patients seemed healthier, if anything.

“For example, the rate of diabetes in 2013 among established patients was 9.4 percent compared with 5.3 percent for new patients,” they wrote.

It is possible that Athenahealth’s clients are not seeing very many of the people who have managed to get health insurance for the first time, Hempstead said. “I do think that primary care is changing,” she said. It’s possible many new patients are going to retail-based urgent care clinics, which are offering more comprehensive care than quick stitches or a flu test, she said. “It is possible, I think, that there could be some new outlets for primary care that aren’t necessarily being captured,” she said.

It’s also hard to tell how many “new” patients are newly insured, or have perhaps changed doctors for other reasons, such as moving, changing jobs, getting new insurance or something else. “It’s indisputable that there has been an increase in the proportion of Americans who have coverage,” Hempstead said. “I think what is very hard to tease apart is how much of that increase is due to people enrolling in a marketplace plan.”

"Coverage expansion has not increased the proportion of new patients appreciably."

A second report tries to get at some of the other questions about health reform.

The Center for Health and Economy projects that federal subsidies for health insurance on the exchanges plus the federal cost of picking up almost the whole tab for expanding Medicaid will cost federal taxpayers $3.3 trillion over 10 years.

This will probably change, but the bipartisan think-tank founded by conservative economist Douglas Holtz-Eakin projects the costs will be $211 billion in 2014 and $288 billion in 2015. It's something the White House has refused to put a price tag on, arguing only that the reforms will lower overall health spending for the country over time.

The group also projects that 15 million more people will be buying insurance as individuals in the next two years, as opposed to getting employer-sponsored or government health insurance. “The individual market is estimated to expand from 35 million covered lives in 2014 to 50 million by 2016, driven largely by the rollout of the Marketplace,” the report reads.