Who Will Treat Those New Medicaid Patients From the Obamacare Exchanges?

MedicaidU.S. GovernmentHealth care providers are showing a certain lack of enthusiasm about the Affordable Care Act. Because of low reimbursement and bureaucratic headaches, both state and national surveys showing physicians unenthusiastic about seeing patients who get coverage through the Obamacare exchanges. And that's for private insurance. But Healthcare.gov and the state exchanges have been more successful so far at signing people up for Medicaid than private plans—and many Medicaid patients are already having trouble finding doctors. So...Who is going to see these new Medicaid enrollees?

When it announced the underwhelming Obamacare enrollment figures (PDF) to-date on November 13, the department of Health and Human Services said that 106,185 people had "selected a Marketplace Plan," but that 396,261 persons had been "determined or assessed eligible for Medicaid/CHIP" (Children's Health Insurance Program).

That's a problem. A 2012 survey (PDF) by Jackson Healthcare, a medical staffing company, found that, while 64 percent of physicians nationally are taking new Medicaid patients, "A majority of physicians across many specialties said they could no longer afford to accept new Medicaid patients due to declining reimbursements. States where physicians were least likely to accept new Medicaid patients were New Jersey, California and Florida."

In fact, last week, the Courier-Post, a south New Jersey paper, reported that Medicaid patients in that state may be signed up for medical care, but they're having serious problems finding providers:

Midway through her third pregnancy, Grace Ewing spotted a disturbing notice on the counter at her obstetrician’s office.

Her Advocare doctor could no longer accept the UnitedHealthcare Community Plan as of Oct. 1, since the Medicaid managed care organization terminated its contract with the provider network.

Like 25,000 other Advocare patients in New Jersey, the practice told her she would have to find a new provider — and quickly.

But it was no easy task. For the next several weeks, the 28-year-old called obstetricians listed on the managed care company’s website. She wanted to find a female doctor within a reasonable distance from her Bellmawr home, who could deliver her baby at Virtua.One office worker after another told her the same thing: “We used to accept it, but we don’t anymore.” ...

Nearly 1.3 million New Jerseyans — about 15 percent of the state’s population — are enrolled in Medicaid, most through plans administered by four managed care organizations.The number of people covered by NJ FamilyCare is expected to swell next year, as an additional 300,000 uninsured residents will be eligible for free coverage, thanks to the Affordable Care Act.

The article adds that 54 percent of doctors in the state don't take take new Medicaid patients. Not surprisingly, low reimbursement is cited as a major reason. There is already a doctor shortage before the expected influx of new Medicaid patients.

None of this should be a surprise. Physician dissatisfaction with Medicaid is not a new proble, Pharmacies, too, were refusing Medicaid patients years ago because of rock-bottom reimbursement. Soon after the Affordable Care Act passed, health experts pointed to Medicaid as a major vulnerability in the law—coverage without providers is no coverage at all.

And yet... Here we are.

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  • Ted S.||

    Oh, the government will figure out a way to force doctors to accept Medicaid patients: if you don't spend a certain number of hours a year serving Medicaid patients, you lose your license.

    Why do you think I keep suggesting we put the same horrid regulations on lawyers first before we try them on doctors?

  • Fist of Etiquette||

    Oh, the government will figure out a way to force doctors to accept Medicaid patients...

    They would never do that.

  • Brutus||

    And it's just a little Surgeon General warning on the side of each pack! It'll never go further than that.

  • Sevo||

    ..."if you don't spend a certain number of hours a year serving Medicaid patients, you lose your license."

    The AMA would SCREAM, but some of the MDs who supported this ought to get every one of the Medicaid patents.
    2-1/2 minutes a piece, pal, you asked for it!

  • JeremyR||

    Doctors are given a government protected monopoly on health care.

    Go ahead, try to practice it without a license and see what the government does.

    So they shouldn't complain if they end up getting forced to take patients by the government. They've used the government to force patients to go to them.

  • Brian||

    It's called "single payer".

  • GregMax||

    Not single payer . . . single borrower.

  • BladeDoc||

    Yep, can't be done on federal level because licensure (except DEA license) is state by state. But it absolutely could be done on a per state basis.

  • Bryan C||

    They'll try exactly the same end-run the did with the state-run insurance commissions. Doctors need to get out in front of this before they find themselves listed among the wreckers and hoarders.

  • Bill||

    I see where you are going with this comrade.

  • Rich||

    if you don't spend a certain number of hours a year serving Medicaid patients, you lose your license.

    A cleaner approach would be to require Medicaid patients to go to *military* doctors.

  • montana mike||

    Doctors....Yaaaay, more government paper work, cocks pistol and slowly raises....

  • nova3930||

    And when they try that, .gov is going to find out just how many Drs are prepared to hang it up and go home rather than be a de facto .gov employee.

    My wife is one and among our circle of friends in the medical community, virtually all of them are prepared to quit. That's a population of doctors

  • nova3930||

    Comment was cut off...

    That's a population of doctors less than age 35. Imagine what would happen with all the old timers.

    .gov can make doctors see medicaid patients, but they can't make doctors show up for work every day.

  • Bryan C||

    But I wonder how many doctors have been a smidge too generous with their prescriptions, or accused of indiscretions with patients, or may have fudged a few things to get tests or routine procedures covered by insurance. Any cash payments that slipped through the cracks? Those could have some pretty serious legal and professional consequences.

    In fact, it looks like you're coming due for a full administrative review of all your medical and financial records. So, what level of voluntary Medicare quota should we sign you up for? Or shall we sit down and audit these electronic records together right now? I thought so.

  • Sevo||

    'Nice little practice you have there. Shame if anything happened to it.'
    Right?

  • Len Bias||

    "Who Will Treat Those New Medicaid Patients From the Obamacare Exchanges?"

    What difference, at this point, does it make if anyone treats them?

    All that matters is that access to health care has increased in theory, even if not in reality.

    Not understanding that makes you anti-ACA types heartless jerks.

  • BFawlty||

    And Racist!

  • Almanian!||

    We do you think the government took over the student loan bidness? To make sure to provide enough for allll those news doctors that US medical schools are graduating. Right now. As we speak.

    Are you people TOTAL retards?

  • Almanian!||

    For tonight, it may be appropriate to read "we" as "why" in some instances.

    Please carry on, libertardians.

  • Contrarian P||

    I'm really not sure what your point is. Perhaps you should try again.

    Do you mean that the government started subsidizing loans in order to pay for med school educations for doctors? I'd say there are no facts that show that. Or do you mean that there was a shortage of available credit, so the government had to step in? I don't think the data support that either.

    By the way, the number of new physicians is not adequate to meet the demand, particularly in the area of primary care, and is not projected to be any time in the near future. So again, not sure what you're talking about here. Perhaps you aren't sure either.

    Maybe you should think about providing some evidence to support your assertions rather than engaging in childish name calling. Might make your points look more serious.

  • larry hammond||

    The Government already will forgive some to all of your student loan if you take the "right" jobs for the approved amount of time. Not really a stretch to think that they will pay for people to become Dr.'s. Of course that is just what we want, Dr.'s with a government union mentality. Brilliant.

  • SQRLSY One||

    A simple solution is at hand, Dudes, Dudettes, and Dudesses… All we need to do is to declare that all expertologists of docterology are slaves to Government Almighty, that they are hereby drafted in the War on Lack of Medical Care, and shall be paid by the opportunity to purchase raffle ticket for the one-in-a-Gazzillion chance of being able to Suck Donkey Dick w/Emperor Obutt-Hole… They will then fall all over themselves so as to willingly enslave themselves to Guv-Mint Almighty… Problem solved! Yer welcome!!!

  • Sevo||

    "They will then fall all over themselves so as to willingly enslave themselves to Guv-Mint Almighty"

    In the run-up to this mess, it seemed quite a few were convinced it was just going to guarantee their practice, forgetting that getting paid by the government means taking orders from the government.

  • Bryan C||

    The just assumed they'd be the ones getting paid, and that other people would be the ones getting the orders. A common misunderstanding.

  • Sevo||

    "The just assumed they'd be the ones getting paid, and that other people would be the ones getting the orders. A common misunderstanding."

    Yes, and the pigs are squealing now that they tried signing up for O'care and found THEY were paying for it instead of the 'others'.

  • Dave Krueger||

    Not to worry. Simple legislation requiring doctors to accept a certain number of medicaid patients in order to keep their license to practice is all that's required.

    Obamacare is not going away despite all the dire predictions that it is going to collapse. It will just be followed by a perpetual string of band-aid legislation (or executive dictates, as the case may be). Of course, if the republican circus clowns happen to wrest control of Congress away from the democrat circus clowns, we might see Obamacare transformed into a new mutation, but it's not likely to be much better. Republicans like to talk free market, but don't act free market. Any legislation that replaces Obamacare is going to have to grease the same palms that Obamacare had to grease. Fortunately for the republicans, when it comes to palm-greasing, they have no more qualms than the democrats.

  • JeremyR||

    People seem to forget the basic idea of Obamacare was supposed to be the Republicans answer to single player.

    Even this site advocated that premise (force people to buy insurance). at one time.

    http://reason.com/archives/200.....tcontainer

  • Sevo||

    I'll presume Bailey figured the devil was in the details. He proposed a high-deductible and HSA contributions.
    But it still was a mandatory-purchase program. I'll bet Bailey isn't bragging about that now.

  • JWatts||

    To be fair, I don't see how you can avoid single payer and still get universal coverage without some kind of mandate.

  • Sevo||

    JWatts|11.25.13 @ 11:35PM|#
    "To be fair, I don't see how you can avoid single payer and still get universal coverage without some kind of mandate."

    We had 'universal coverage'.
    For those who didn't have self-paid coverage, they managed to get themselves to the ER. Sorta messy, but amazingly, they got care and it didn't take a hundred-million dollar fucked-up web site, not the intrusion of the IRS to accomplish it.
    The claim was this was HORRIBLE! So claimed by those who presumed that a lack of government control makes things horrible.
    It wasn't. Given the limits of what can be done and paid for, it was a whole hell of a lot better than what we have been handed by that miserable, stinking HAG and that lying piece of shit in the WH.

  • PapayaSF||

    Less regulation + technological advances = a freer market in medicine = lower prices = near-universal coverage. Charity assisted by some tax dollars can take care of the rest.

  • NotAnotherSkippy||

    So Republicans advocated for expanding Medicaid? Umm, no.

    Read Bailey's piece again. This time for comprehension. Yes, he talks about mandating health insurance coverage, but it's catastrophic coverage. And he advocates for elimination Medicare and Medicaid under such a system. Tell me that's the basic idea of BarryCare. Here's a hint: the way it addresses most of the uninsured is through Medicaid. Does that sound like the free market system advocated in Bailey's piece to you?

  • #||

    You mention a part that a lot of people miss. The bulk of the currently uninsured were expected to get insurance through either Medicaid or the employer mandate. The current individual market exchanges are made up mostly of people who either are already insured or are people who were only temporarily uninsured because of moving, job loss, divorce or so forth.

    So really it's medicaid that is doing the bulk of the newly insured lifting. The exchanges primary purpose was to socialize costs making younger people pay more to subsidize older people.

  • Sevo||

    "So really it's medicaid that is doing the bulk of the newly insured lifting."
    I'm not yet convinced there is a 'newly insured' cohort.

    "The exchanges primary purpose was to socialize costs making younger people pay more to subsidize older people."
    Good luck with that, Obo (not you). Krugy claims it's working in CA, and given the idiocy of the CA voters, it might be possible. But I've yet to hear of the young rushing to buy what they don't think they need elsewhere.

  • Bryan C||

    It'll be repealed before next summer. But I'm equally skeptical about the replacement.

  • JeremyR||

    That's the thing about our healthcare system. As it was, we already had fewer doctors per patient than other countries. Obamacare does nothing to fix that, so it's just going to force existing doctors to work more, or more likely, people still won't have health care

  • NotAnotherSkippy||

    Which other countries? We have more doctors per capita than Singapore, Japan, or Canada. The NHS has 10% more. Cuba has over twice the number we do. Given the choice between the US and Cuba I'll take the former any day of the week.

    It'll force doctors who see Medicaid and medicare patients to work more. Or there will be fewer doctors who see Medicare and Medicaid patients.

  • OneOut||

    This is all much ado about nothing.

    Just deem them covered and LET'S MOVE...FORWARD!

  • steve baker||

    I work part-time in the office of a small dental clinic that gives priority to pediatric MA patients. The reimbursement rates run about 30%, with a few as low as 17%.

  • Rich||

    "Thanks for your contribution!"

    /Bill Clinton

  • Jquip||

    Price controls: If they're good enough for America, they're good enough for Venezuela.

  • Sevo||

    Hey, and maybe we can match the quality of Venezuela's currency!

  • widget||

    "Nearly 1.3 million New Jerseyans..."

    That's the first time I've come across "New Jerseyan", and I grew up the Delaware Valley, but it has been quite a while. Would there be "Camdenites" or "Camdenians" living in Camden? Would there be "Trentonians" or "Trentonites" living in Trenton?

  • PapayaSF||

    I thought it was "Jerseyoids."

  • Number 2||

    Yes, they are Trentonians. That is the name of the local newspaper.

    http://www.trentonian.com

  • JWatts||

    All joking aside, I foresee a minority of Doctor's agreeing to take these new patients at low reimbursement rates. And the predictable reaction on the Left will be outrage at 'greedy' Doctors and demands that they be required to accept new patients. Keep the popcorn handy, this show has a long way to run, as of yet.

  • Sevo||

    JWatts|11.25.13 @ 11:40PM|#
    "All joking aside, I foresee a minority of Doctor's agreeing to take these new patients at low reimbursement rates."

    The rationing of care will be decided by government imbursement (reimbursement? What's with the 're'?) rates and of course when it becomes obvious there is rationing, it will be blamed on the market.
    We have among us several ignorant assholes who do so already, the most obvious being shreek who claims banks regulated and directed to do things by the government are an indication of 'market failures'.

  • jace||

    If you like your medical license, you can keep your medical license. Period*.

    *ical reviews of Medicaid patient ratios being satisfied.

  • arlanvoa47||

    just before I looked at the receipt 4 $9739, I didn't believe ...that...my father in law was like actualey receiving money part-time on their apple laptop.. there uncles cousin has done this 4 only nineteen months and a short time ago cleared the mortgage on their place and bought Toyota. visit

    ==============================================

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  • in4mation||

    Next they will pass a law forcing doctors to accept Medicare.

  • kenezen||

    Seniors should shiver when they dream at night all over the country as this Medicaid news of millions of new subscribers becomes reality!
    Near the end of 2011, Forbes verified: " President Obama subtracted $716 Billion from from Medicare in order to fund $1.9 trillion in new health care spending through the law’s expansion of Medicaid."

    ONLY Now we know why! The Obama administration knew of the magnitude of the increase in Medicaid coming.
    The end of this spending is not nearly in sight. More Medicare money will be hijacked to compensate States for their required Medicaid expenses counting on fast reimbursements from the Central Government. The odds
    are only part will come back.

    Medicare will be continuously robbed until most doctors treat Medicare like medicaid and physicians and hospital disappear. IT will be the Seniors that get badly hurt without their doctors and hospitals as well as most Aftercare. Be Ready Think of me as PAUL REVERE! Seniors!! Medicare will become Medicaid with very restricted and poor access and many side benefits are going away after the 2014 election. That's the only thing holding these draconian cuts up!!

    Seniors beware of the Democrats tied to Obama! Look at what they did in the Senate against our Constitutional structure created by the Founders!! Hedgemastermb.blogspot.com READ!

  • ReasonableS||

    New York State Medical Society doesn't seem to have a web presence.

    MGMA is the Medical Group Management Association. I couldn't find out if the physicians they polled were their members or a more representative sampling of the population.

    Anyone know about these information sources and their objectivity?

  • UnCivilServant||

    I'm fairly sure that the doctor's offices in New York can't take real medica* patients because they're too busy processing fake patients. Of course, since these clinics are owned by the legislators, the response from the government was to cut the anti-fraud budget and spend more on the two programs.

  • Karl F||

    The government could try market incentives like raising the Medicaid reimbursement rates for physicians who treat these patients. That would seem to be the best approach.

  • Sevo||

    "The government could try market incentives like raising the Medicaid reimbursement rates for physicians who treat these patients. That would seem to be the best approach."

    I presume you're volunteering to have your taxes raised to do so?
    I'm not.

  • thorax232||

    Whatever drains the money out. It seems as if the country is purposely being destroyed, there really is no other logical answer.

  • xsnake||

    Fairly simple to have Bamstercare paid for fairly......At the polls, all ballots (Democrat and Republican) will be on different colored forms. Anyone who chooses Dem ballot should be charged a Medical Expense Tax (afterall, Bamstercare has been ruled a "tax").
    That will pay for EVERONE'S care, as only Democrats passed the bill.

  • ||

    To an Australian, it's surprising that a woman would want an obstetrician for a pregnancy with no complications (yes, the article didn't say there were none in that case). Here you can just visit the midwives at a public maternity ward who will check on the course of your pregnancy and ultimately deliver your child, with the help of an obstetrician if required -- which it usually isn't

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