California Medicaid Conundrum: What Good is Health Care If No Doctor Will See You?


Somehow, the architects of Obamacare in D.C. and Gov. Jerry Brown's helpers in Sacramento couldn't see this one coming: A huge increase in the number of patients served by Medic-Cal, the Golden State's version of Medicaid, coupled with no increase in the number of doctors and a decrease in reimbursement rates has led to longer and longer wait periods.

Since January 2014, reports Tracey Seipel of the Mercury News, 2.7 million new people have signed up for Medi-Cal under the expansion made possible my Obamacare.

"California did a good job of getting people signed up, but they basically stuck their heads in the sand and assumed that California physicians would just jump right on board and want to take more Medi-Cal patients," said Dr. Del Morris, president of the California Academy of Family Physicians, which represents many of the first-line doctors who treat Medi-Cal patients. "It's unacceptable to say, 'We are not ready for you yet, you'll just have to suffer with your disease.'"

Morris and other experts say the situation is about to get worse, in part because of Medi-Cal's health care reimbursement rates.

For years, the rates paid by Medi-Cal—called Medicaid in the rest of the country—have been among the nation's lowest. A provision of Obamacare hiked the rates for primary care doctors to the substantially higher Medicare rates for two years, but those increases ended on Dec. 31. A second blow came last month when the state cut the Medi-Cal reimbursement rate by another 10 percent, a reduction approved by California lawmakers in 2011 but delayed in a court battle that doctors ultimately lost.

It's worth pointing out that just because California cut reimbursement rates, it doesn't mean the state is spending less on Medi-Cal. Medicaid funding keeps going up in California (see chart). Indeed, it is either the single-biggest or second-biggest line item in every state's budget.

The article cites a study from the California Health Care Foundation that surveyed doctor availability in Medi-Cal between 2011 and 2013, before the Medi-Cal expansion. Even then, the number of primary-care doctors was below federal recommendations for Medicaid programs.

The ratio of primary care doctors participating in Medi-Cal was 35 to 49 FTEs per 100,000 enrollees, well short of the range of 60 to 80 that the federal government estimated are needed. The ratio of non-primary physicians participating in Medi-Cal was between 68 and 102 FTEs per 100,000 enrollees, a range which overlaps with the federal estimate of need (85 to 105 per 100,000).

Nope, no way you could have guessed that any problems would arise.

And then there's the 30 percent increase between 2013 and 2014 in "treat and release" visits to emergency rooms by Medi-Cal patients. Recall that getting the uninsured covered through Obamacare was supposed to reduce exactly this sort of behavior.

Seipel opens her article with the story of 49-year-old Julie Moreno, who was one of the 2.7 million folks newly covered by Medi-Cal. After waiting three months for cataract surgery and constantly being told that there were "no slots" available, Moreno ended up borrowing $14,000 for private treatment.

So she did get health care. Is that a win for Obamacare? Or a loss for everyone involved? I'm inclined to think the latter.

Hat Tip: Conn Carroll's Twitter feed.

Robert Graboyes of the Mercatus Center at George Mason University has some good ideas about growing the supply of health care (not insurance or coverage, but actual goddamn health care!). He's worth listening to. Go here for more links and details.