The Doctor Will Not See You Now

Even if implementation of ObamaCare goes more or less as planned and ends up expanding health coverage to about 30 million over the next decade, as the latest Congressional Budget Office report on the law projects, it is still quite likely that significant health access issues will remain.

As The Washington Post's Sarah Kliff reports today, a recent study by a researcher at the Center for Disease Controls recently looked at 2011 survey of doctors and found that nearly a third said they did not accept new Medicaid patients last year:

[The study] used a survey of 4,326 office-based physicians from across the country to find that 69.4 percent said they were accepting new Medicaid patients. That number was significantly lower than those accepting privately-insured subscribers (81 percent) or Medicare patients (83 percent), indicating that this wasn't just about doctors being overbooked – it was specific to the Medicaid program. The lower acceptance of Medicaid programs also held when Decker broke down doctors by specialists and primary care providers.

Given that much of ObamaCare's coverage expansion relies on Medicaid, this is not an encouraging sign for the millions of individuals who are supposed to be shuffled into the program as a result of the law. 

Indeed, as The New York Times reported recently, the law's coverage expansion is likely to exacerbate a growing doctor shortage that was already in the works before the law passed:

The Association of American Medical Colleges estimates that in 2015 the country will have 62,900 fewer doctors than needed. And that number will more than double by 2025, as the expansion of insurance coverage and the aging of baby boomers drive up demand for care. Even without the health care law, the shortfall of doctors in 2025 would still exceed 100,000.

Health experts, including many who support the law, say there is little that the government or the medical profession will be able to do to close the gap by 2014, when the law begins extending coverage to about 30 million Americans. It typically takes a decade to train a doctor.

"We have a shortage of every kind of doctor, except for plastic surgeons and dermatologists," said Dr. G. Richard Olds, the dean of the new medical school at the University of California, Riverside, founded in part to address the region's doctor shortage. "We'll have a 5,000-physician shortage in 10 years, no matter what anybody does."

Our best real-world test case for the law—RomneyCare, the Massachusetts health care overhaul that served as the model for ObamaCare—makes clear that the problem is real. Despite the highest health coverage levels of any state in the country (somewhere between 94 and 98 percent), some 14 percent of sick adults still reported being unable to access a doctor in the state last year, according to a study by the Harvard School of Public Health. And the problem seems to be getting worse: 63 percent of participants in the Harvard study said they thought their access troubles had become worse in the five years since RomneyCare became law. 

None of these discoveries are recent: We've seen longer lines and hospital wait times in Massachusetts for years, Medicaid (and to a lesser extend Medicare) beneficiaries have had trouble finding willing providers for a long time, and it was clear that a doctor shortage was coming before ObamaCare was passed into law. But ObamaCare's backers in Congress and the White House decided that, despite these problems, it would be a good idea to commit somewhere in the neighborhood of $2 trillion over the next decade to expanding health coverage. So not only did the law fail to solve many of the U.S. health system's existing problems, it also added a fiscal strain that could well make those problems harder to fix.