You’ll be insured, you just may not be able to get care

This article was originally published on heartland.org.

Obamacare is set to provide some 16 million people with health insurance through Medicaid or the new exchanges next year. Unfortunately, their policies may not be worth much, because they may not be able to actually get care.

America is suffering from a doctor shortage. An influx of millions of new patients into the healthcare system will only exacerbate that shortage, driving up the demand for care without doing anything about its supply. Those who get their coverage through Medicaid or the exchanges may feel the effects of the shortage even more acutely, as many providers are opting not to accept their insurance.

Right now, the United States is short some 20,000 doctors, according to the Association of American Medical Colleges. The shortage could quintuple over the next decade, thanks to the aging of the American population and the aging and consequent retirement of many physicians. Nearly half of the 800,000-plus doctors in the United States are over the age of 50.

Obamacare is further thinning the doctor corps. A Physicians Foundation survey of 13,000 doctors found 60 percent of doctors would retire today if they could, up from 45 percent before the law passed.

Rejecting Medicaid Patients

Doctors are also becoming choosier about whom they�??ll see.

They�??ve long limited the number of Medicaid patients they�??ll treat, because of the program�??s low reimbursement rates. According to a study published in Health Affairs, only 69 percent of doctors accepted new Medicaid patients in 2011. In Florida, just 59 percent do so. A survey by the Texas Medical Association of doctors in the Lone Star State found 68 percent either limit or refuse to take new Medicaid patients.

Medicaid pays about 60 percent as much as private insurance. For many doctors, the costs of treating someone on Medicaid are higher than what the government will pay them.

These underpayments have grown worse over time, as cash-strapped states have struggled to rein in spending on Medicaid. Ohio hasn�??t increased payments to doctors in three years; Kentucky hasn�??t raised them in two decades. Colorado, Nebraska, South Carolina, Oregon, and Arizona all cut payments in 2011.

By throwing nine million more people into the program without fixing this fatal flaw, Obamacare will make it even harder for Medicaid patients to find doctors.

Restricting Access to Networks



Healthcare providers are signaling they may turn away patients who purchase insurance through the exchanges, too.

In California, for example, people covered by Blue Shield�??s exchange plan will have access to about a third of its physician network. The UCLA Medical Center and its doctors are available to customers of just one plan for sale through the state exchange, Covered California. And the prestigious Cedars-Sinai Medical Center is not taking anyone with exchange insurance.

Patients who live in central and southern Maine, meanwhile, stand to lose access to local doctors and hospitals if they buy coverage from the state�??s largest health insurer through the exchange. In order to keep premiums down and comply with all the coverage mandates Obamacare imposes, Anthem Blue Cross Blue Shield is looking to contract with just one hospital network, MaineHealth. �??This is critically important in offsetting premiums increases�?� driven by Obamacare, rhe insurer told regulators.

The partnership might not be a problem if Mainers had other choices through the exchange. But thus far, Anthem and a small, nonprofit start-up are the only two firms that have applied to sell coverage on the exchange.

Emergency Rooms Already Crowded



If Medicaid patients and new exchange enrollees can�??t actually see doctors, they�??ll head to emergency rooms for care. But the nation�??s ERs are already in crisis. More than half are over capacity, after some 650 shut down over the past two decades.

With Medicaid patients being twice as likely to use the ER as those with private insurance, Obamacare could lead to catastrophic overcrowding. Ryan Stanton, director of emergency medicine at a Kentucky hospital, called it �??a perfect storm that will lead to decreased access.�?�

The evidence backs him up. Harvard researchers found emergency room utilization increased in all 11 Massachusetts hospitals they studied after the Bay State implemented a carbon copy of Obamacare back in 2006. To try to alleviate the doctor shortage, some lawmakers have proposed increasing federal funding for physician residencies. Others, particularly at the state level, have argued for relaxing �??scope-of-practice�?� rules to allow nurse practitioners and physician assistants to assume many functions that have historically been the sole province of doctors.

But neither approach will have a sufficient impact on the supply of care to counterbalance the immense increase in demand Obamacare�??s Medicaid expansion and new exchanges will engender. And no provider will be excited to accept the government�??s cut-rate reimbursements, which the federal health care law does nothing to fix.

The first step in addressing the nation�??s shortage of doctors is full repeal of Obamacare. The second is the installation of market-based reforms in its place. That�??s the best way to ensure Americans can actually get care when they need it.

Sally Pipes (spipes@pacificresearch.org) is president and CEO of the Pacific Research Institute, a California-based think tank, and the author of �??The Pipes Plan: The Top Ten Ways to Dismantle Obamacare�?� (Regnery Publishing, 2012).