More Insurance, Less Care

From John C. Goodman of Forbes 

"Obamacare is providing health insurance to millions of people. But are they getting more medical care?

According to the White House, 9.7 million people have been added to the Medicaid rolls since October 2013, bringing the total to 68.5 million. More than one-fifth of Americans are now covered by Medicaid.

But having a Medicaid insurance card is not the same thing as having access to medical care. According to a study by the inspector general of the Department of Health and Human Services about half the doctors who are listed by insurers as serving Medicaid patients are not available to treat them. Those who are available often require long waits:

“For example,” the report said, “a number of obstetricians had wait times of more than one month, and one had wait times of more than two months for an enrollee who was eight weeks pregnant. Such lengthy wait times could result in a pregnant enrollee receiving no prenatal care in the first trimester of pregnancy.”

”Primary care providers, such as family doctors, internists and gynecologists, were less likely to offer appointments than specialists, the report said. But specialists tended to have longer wait times, with a median wait of 20 days, compared with 10 days for a primary care provider.”

Moreover, things are about to get much worse. As Robert Pear reports:

For the last two years, the federal government has required state Medicaid agencies to pay at least as much as Medicare pays for primary care services. Family doctors, internists and pediatricians have thus received Medicare-level payments for primary care, with the federal government making up the difference in costs….

But the increase expires on Thursday — just weeks after the Obama administration told the Supreme Court that doctors and other providers had no legal right to challenge the adequacy of payments they received from Medicaid.

Astudyby the Urban Institute estimates that the fee reductions will average 43 percent nationwide. But they could reach 50 percent or more for primary care doctors in California, New York, New Jersey, and Illinois — big states that have all expanded Medicaid under the health law.

A system-wide problem will add to these woes. If the economic studies are correct, the newly insured (both those who are privately insured and those on Medicaid) will try to consume twice as much health care once they have insurance and there may eventually be 25 million of them. Along the way almost everyone else is being forced to have more generous insurance than they previously had and with these new benefits they are likely to seek more care. The result: we are in the process of greatly expanding the demand for care while doing virtually nothing about supply.

At the same time, the nation’s health care safety net is being decimated.  Obamacare is reducing “uncompensated care” funds to safety hospitals at a time when their case load is increasing and states actually have perverse incentives to dump large portions of their Medicaid populations. To add insult to injury, private donations are down for free medical clinics around the country and many are closing their doors.

Bottom line: We have spent an enormous amount of money on health reform. It is not yet clear whether there has been an overall increase in access to care – especially by the most vulnerable patients."