HealthDay News — Uninsured adult patients were spending an average of $160 for a primary care appointment before the implementation of the Affordable Care Act, study findings published in Health Affairs indicate.

Although the Affordable Care Act (ACA) has opened access to health care, “a sizable number of people remain uninsured because they live in states that have not expanded Medicaid coverage or because they feel that Marketplace coverage is not affordable,” wrote Brendan Saloner, PhD, of the Johns Hopkins Bloomberg School of Public Health in Baltimore, and colleagues.

To examine prices for primary care visits offered by clinicians to new uninsured patients prior to ACA insurance expansions, the investigators used data from a 10-state telephone survey in which callers posed as patients.

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The mean price quoted was $160. The prices were significantly lower at family practice offices versus internists, in offices participating in Medicare managed care plans, and in federally qualified health centers. Offices in ZIP codes with higher poverty rates also had lower prices. Less than 18% of callers were told that they could bring less than the full amount to the visit and arrangement payment of the remaining amount later.

“ACA insurance expansions could greatly decrease out-of-pocket spending for low-income adults seeking primary care,” concluded the scientists.

“However, benefits of health reform are likely to be greater in states expanding Medicaid eligibility.”


  1. Saloner B et al. Health Aff. 2015; doi: 10.1377/hlthaff.2014.1258