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.