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


U.S. Government

Health 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.