Disparities in Pediatric Provider Availability by Insurance Type after the ACA in California.

OBJECTIVE: To examine insurance-based disparities in provider-related barriers to care among children in California in the wake of changes to the insurance market resulting from the Affordable Care Act.

METHODS: Our sample included 6,514 children (ages 0-11 years) from the 2014-2016 California Health Interview Survey. We examined parent reports in the past year of 1) having trouble finding a general provider for the child, 2) the child not being accepted by a provider as a new patient, 3) the child's health insurance not being accepted by a provider, and 4) any of the above. Multivariable models estimated the associations of insurance type (Medi-Cal (Medicaid)), employer-sponsored insurance (ESI), and privately purchased coverage) and parent reports of these problems.

RESULTS: Approximately 8% of parents had encountered at least one of the three problems. Compared with parents of children with ESI, parents of children with Medi-Cal or privately purchased coverage had over twice the odds of experiencing at least one of the barriers. Parents of children with Medi-Cal had over twice the odds of having been told a provider would not accept their children's coverage or having had trouble finding a general provider and three times the odds of having been told a provider would not accept their children as new patients. Parents of children with privately purchased coverage had over three times the odds of having been told a provider would not accept their children's coverage.

CONCLUSIONS: Our study found significant disparities in provider-related barriers by insurance type among children in California.