How Have Providers Responded to the Increased Demand for Health Care Under the Affordable Care Act?

Providers expanded capacity and staff to meet increased demand under ACA.



The issue

The Affordable Care Act (ACA) increased the number of people with health insurance, leading to greater demand on providers for health care services. Interviews with health care stakeholders in five communities that saw some of the largest percent increases in numbers of insured people (Detroit, Mich.; Lexington, Ky.; Sacramento, Calif.; Spokane, Wash.; and Morgantown, W. Va.) give insight into how providers are responding to this increased demand.

Key Findings

  • Providers in the five communities increased capacity in response to increased demand by relying on revenue from newly insured patients, especially those newly covered by Medicaid.

  • Health care systems and community health centers hired new staff, opened new delivery sites, including urgent care centers and retail clinics, and implemented longer hours.

  • In addition to physicians and advanced practice clinicians, providers also hired administrative and health information technology staff to help manage the increased demand.

  • Mental health and substance abuse disorder treatment were the most significant unmet needs, even after the expansion of health care capacity.


Health care providers have adapted to the increased demand for services caused by the ACA. They responded by hiring more staff, relying more on advanced practice clinicians, and expanding facilities and hours. Despite increases in provider capacity, however, there are still areas of unmet need and persistent professional workforce shortages that were exacerbated by the ACA’s coverage expansions.

About the Urban Institute

The nonprofit Urban Institute is dedicated to elevating the debate on social and economic policy. For nearly five decades, Urban scholars have conducted research and offered evidence-based solutions that improve lives and strengthen communities across a rapidly urbanizing world. Their objective research helps expand opportunities for all, reduce hardship among the most vulnerable, and strengthen the effectiveness of the public sector. Visit the Urban Institute’s Health Policy Center for more information specific to its staff and its recent research.