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Patients and Providers Speak: Early Care Experiences Under the ACA

American Institutes for Research

How successful is the ACA for Californians who seek and provide care? This study offers early experiences of consumers and clinical organizations in the state.

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As of April 2014, more than 1.4 million Californians had selected a non-Medi-Cal health plan through Covered California, the state's health care marketplace. What was their experience of seeking and receiving care through plans made newly available under the ACA?

This study provides early insight into the successes and challenges of the ACA from the perspectives of consumers as well as from providers in clinical organizations in California. It is based on focus groups with 74 consumers and interviews with 64 health care providers in four areas of the state. Because consumers surveyed were among those quickest to enroll and use services, they are not representative of all Covered California enrollees.

April 2015 Update

AIR conducted follow-up interviews in January 2015 with 59 health care providers to gauge their views on the first full year's experience. The follow-up study is available under Document Downloads.


Consumers enrolled in qualified health plans through Covered California described challenges associated with understanding their coverage and obtaining care, yet were generally happy with the care they received since January 2014. Some highlights from the findings include:

  • Consistent with challenges in understanding and using health insurance that predated the ACA, many consumers had difficulty understanding their cost-sharing responsibilities and what services were provided under their new health plans.
  • Inaccurate or ambiguous information about health plan networks contributed to frustration and dissatisfaction for some consumers.
  • Despite these challenges, consumers had generally positive experiences with their health care providers, were grateful to be covered by health insurance at all, and found their premiums and copays to be not only affordable but much lower than what they were used to paying.
  • Spanish-speaking consumers had been able to receive care in the language they prefer.
  • Providers reported slight upticks in chronically ill patients seeking care but were able to accommodate their needs.

Only months after launch, Covered California and its contracting plans continue to refine products and approaches. These research findings suggest opportunities for improved transparency and greater consumer education as implementation continues to unfold.

The complete report and several supporting documents are available under Document Downloads.

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