Obamacare

Paying Doctor

Insurance, not access

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Need a doctor? Be prepared to wait, even if you have health insurance. The Patient Protection and Affordable Care Act, commonly known as Obama­Care, is expected to extend health coverage to more than 30 million people during the next decade. But many patients will still have a tough time finding someone to provide care.

Much of ObamaCare's expansion of health coverage comes from Medicaid, a program for disabled and low-income individuals that is jointly financed by state and local governments. In July, the Congressional Budget Office, taking into account a Supreme Court ruling that lets states opt out of the Medicaid expansion without penalty, estimated that the program will account for 7 million newly covered individuals. But covered is not the same as treated: Sandra Decker, an economist with the U.S. Centers for Disease Control and Prevention, reports in the August issue of Health Affairs that 31 percent of physicians surveyed in 2011 said they were turning away new Medicaid patients, due primarily to the program's low reimbursement rates.

In the same survey, 17 percent of providers said they were declining to accept Medicare beneficiaries for similar reasons. This problem is apt to get worse. In an April report, Medicare's chief actuary, Richard Foster, warned that "severe problems with beneficiary access to care" are likely without congressional intervention to override scheduled payment cuts to providers. But there are costs to intervention as well. "Overriding the productivity adjustments," Foster wrote, "would lead to substantially higher costs for Medicare in the long range than those projected under current law."