11/28/13, "Medicaid Growth Could Aggravate Doctor Shortage," NY Times, Abby Goodnough
"Dr. Ted Mazer is one of the few ear, nose and throat specialists in this region who treat low-income people on Medicaid, so many of his patients travel long distances to see him.
But now, as California’s Medicaid program is preparing for a major expansion under President Obama’s health care law, Dr. Mazer says he cannot accept additional patients under the government insurance program for a simple reason: It does not pay enough.
“It’s a bad situation that is likely to be made worse,” he said.
His view is shared by many doctors around the country. Medicaid for years has struggled with a shortage of doctors willing to accept its low reimbursement rates and red tape, forcing many patients to wait for care, particularly from specialists like Dr. Mazer.
Yet in just five weeks, millions of additional Americans will be covered by the program, many of them older people with an array of health problems. The Congressional Budget Office predicts that nine million people will gain coverage through Medicaid next year alone. In many of the 26 states expanding the program, the newly eligible have been flocking to sign up.
Community clinics, which typically provide primary but not specialty care, have expanded and hired more medical staff members to meet the anticipated wave of new patients. And managed-care companies are recruiting doctors, nurse practitioners and other professionals into their networks, sometimes offering higher pay if they improve care while keeping costs down. But it is far from clear that the demand can be met, experts say.
In California, with the nation’s largest Medicaid population, many doctors say they are already overwhelmed and are unable to take on more low-income patients. Dr. Hector Flores, a primary care doctor in East Los Angeles whose practice has 26,000 patients, more than a third of whom are on Medicaid, said he could accommodate an additional 1,000 Medicaid patients at most.
“There could easily be 10,000 patients looking for us, and we’re just not going to be able to serve them,” said Dr. Flores, who is also the chairman of the family medicine department at White Memorial Medical Center in Los Angeles.
California officials say they are confident that access will not be an issue. But the state is expecting to add as many as two million people to its Medicaid rolls over the next two years — far more than any other state. They will be joining more than seven million people who are already in the program here. One million of the newly eligible will probably be enrolled by July 2014, said Mari Cantwell, an official with the state’s Department of Health Care Services.
On top of that, only about 57 percent of doctors in California accept new Medicaid patients, according to a study published last year in the journal Health Affairs — the second-lowest rate in the nation after New Jersey. Payment rates for Medicaid, known in California as Medi-Cal, are also low here compared with most states, and are being cut by an additional 10 percent in some cases just as the expansion begins....
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....
Dr. Paul Urrea, an ophthalmologist in Monterey Park, said he was skeptical of “blue-sky scenarios” suggesting that all new enrollees would have access to care. “Having been in the trenches with Medi-Cal patients who have serious eye problems,” he said, “I can tell you it’s very, very hard to get them in to see those specialists.”
Dr. Urrea said that when he recently tried to refer a Medicaid patient with a cornea infection to another eye specialist, he was initially informed that the specialist could not see the patient until February. “And this is a potentially blinding condition,”he added....
Oresta Johnson, 59, who sees Dr. Mazer through the state’s interim health care program for low-income residents but will switch to Medicaid in January, said she had faced “excessively long” waits to see specialists who could treat her degenerative joint disease. Dr. Mazer is monitoring her thyroid gland, she said, and she is hoping she will not have a problem getting back in to see him next spring, when she may need a biopsy."...
11/29/13, "Medicaid Fraud: Obamacare promise of free quality healthcare," Legal Insurrection, William a. Jacobson
"The result of all this will be a targeting of doctors. Forcing doctors to accept Medicaid patients will be the inevitable solution."
11/29/13, "Doctors Don’t Like What They’ve Seen In ObamaCare," IBD Editorial
"Three years ago our IBD/TIPP Poll found that nearly half of doctors said they would consider quitting their practices if the Democrats' health care overhaul became law. So how do they like it now? Not much.
But that was almost four years ago. In late 2013, doctors are finding out what is in ObamaCare and they don't like what they see. Poll results released earlier this month by Jackson & Corker found that 61% of physicians said their opinion of the ACA "has changed for the worse." Only 31% said it had not.
The survey, which polled more than 3,000 doctors, also found that 80% of physicians say Americans currently insured will have to pay more under ObamaCare — remember the Obama promise of bending the cost curve downward? — while 76% see overall health care costs rising due to the ACA.
And what will America get in exchange for increasing costs? Quite likely, substandard results. Six in 10 doctors, the poll found, believe the quality of patient care will be hurt by ObamaCare, while 57% say the law will have negative impacts on treatment decisions.
Other highlights from the poll:
• More than seven in 10 doctors (73%) say patients will have less choice.
• Not quite half (44%) say they will not participate in the ObamaCare exchanges.
• More than half (56%) want the Affordable Care Act to either be repealed or defunded.
• Nearly two-thirds (66%) anticipate spending more time on administrative burdens.
While readers digest these numbers, they should also consider yet another now-they-tell-us story from the media that actively campaigned for passage of ObamaCare.
On the day the nation celebrated Thanksgiving, the New York Times — our alleged "newspaper of record" — revealed that Medicaid growth under ObamaCare "could aggravate" the doctor shortage that already plagues that program.
As many as 9 million new Americans will be eligible for Medicaid under ObamaCare, says the Congressional Budget Office, which is going to overwhelm Medicaid doctors who often are already flooded with patients. Many physicians will simply say they cannot take new Medicaid patients.
Almost three years have passed since the ObamaCare legislation was signed into law, and all we've seen so far is failure. So we think it's legitimate to ask: Is there any evidence that the Democrats' health care overhaul actually has produced any benefits at all?
None that we can see. It's been as disastrous as we expected and its woes will only multiply. Any attempt by Washington to ensure and provide health care for 315 million Americans is not only doomed to failure but is guaranteed to make things worse.
How could it not? Central planning has never delivered on its promises and there's no reason to think it ever will. America's doctors recognize this. If only the country's lawmakers were as sharp as doctors."