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For Many, ACA Will Offer Access in Name Only


Thanksgiving day saw the NYT reeling in shock as yet another major Obamacare meltdown looms. One key way the Affordable Care Act was supposed to expand access to health insurance was through relaxing eligibility restrictions for Medicaid: the CBO predicted that nine million people will gain coverage through the Medicaid expansion this year alone.

But there’s a problem. Medicaid notoriously pays doctors at much lower rates than they get from non-Medicaid patients, so they are often reluctant to take Medicaid patients on. And it turns out the ACA will exacerbate that problem even as it increases the ranks of Medicaid patients. For example, even before the expansion in California, only 57 percent of doctors accepted Medicaid patients. Now with the expansion and confusions created by the law, that number is expected to drop. More:

The health care law seeks to diminish any access problem by allowing for a two-year increase in the Medicaid payment rate for primary care doctors, set to expire at the end of 2014. The average increase is 73 percent, bringing Medicaid rates to the level of Medicare rates for these doctors.

But states have been slow to put the pay increase into effect, experts say, and because of the delay and the fact that the increase is temporary, fewer doctors than hoped have joined the ranks of those accepting Medicaid patients.

“There’s been a lot of confusion and a really slow rollout,” Ms. Folberg said, “which unfortunately mitigated some of the positive effects.”

Once more we see a well-intended provision of the Affordable Care Act go awry because the administration seemed  unaware that efforts to change parts of a complex and delicately-balanced system can have seriously bad side-effects. But more than that, this story illustrates a crucial point of weakness we’ll be hearing about more and more as the law gets implemented: the nexus at which patient and doctor meet.

It’s one thing to give someone Medicaid or subsidize insurance purchased on the exchange; it’s another for that patient to be able to use that insurance to get quality, timely care from a doctor of his choice.  Whether through network restrictions, Medicaid overflow, or a national doctor shortage, various kinds of doc shocks could wind up showing the newly insured that they have access in name only.

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  • Steve

    Good points are made in this post, unfortunately, the misidentification of Medicare instead of Medicaid distracts from you point.

  • APR

    I think you mean Medicaid, not Medicare.
    I like your POV. Great job!

  • Reticulator

    This is why it would have been better for health care reform not to have been comprehensive reform.

  • NCMountainGirl

    Welcome to the unicorns and glitter version of health care.

  • AnnSaltzafrazz

    You can then look ahead further: as fewer doctors choose to deal with Medicaid and Medicare, you’ll see in the demographics of doctors’ patients shift. More will focus on younger patients, who are usually healthier than the elderly. These are the people who are more in need weight loss assistance, plastic surgery, and sexual performance medications than of intense medical interventions. Those shifts are already taking place, and we should see much more of it in the future.

  • Boritz

    Once more we see a well-intended provision of the Affordable Care Act go awry -VM

    Can we make a start on improving the language used to describe this thing. How about instead of ‘well-intended’ go with ‘ill-conceived’. It’s every bit as accurate and completely deserved.

  • toothfairynw

    Poor reimbursement rates are only part of the reason that doctors “opt out” of medicaid. A large majority of these patients are more complex medically, no show appointments more frequently, and take more staff time getting approval for testing, imaging or prescriptions covered. Combine that with reimbursements that don’t even cover your basic overhead and you will start to understand that seeing medicaid patients is actually a losing proposition. Most doctors simply can’t afford to pay to see these patients. Where do you think the money comes from?

  • Jacksonian_Libertarian

    In a free market the supply and demand is balanced, shortages and oversupplies are quickly fixed by price. Obamacare is really like a bull in a china shop, to the extent that people are forced back to paying cash, the healthcare industry will get better.

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