Surprise: Expansion of Medicaid could make doctor shortage worse

The doctor is out.
Disturbing news.

Via the NY Times:

SAN DIEGO — Dr. Ted Mazer is one of the few ear, nose and throat specialists in this region who treat low-income people on Medicaid, so many of his patients travel long distances to see him.

But now, as California’s Medicaid program is preparing for a major expansion under President Obama’s health care law, Dr. Mazer says he cannot accept additional patients under the government insurance program for a simple reason: It does not pay enough.

“It’s a bad situation that is likely to be made worse,” he said.

His view is shared by many doctors around the country. Medicaid for years has struggled with a shortage of doctors willing to accept its low reimbursement rates and red tape, forcing many patients to wait for care, particularly from specialists like Dr. Mazer.

Yet in just five weeks, millions of additional Americans will be covered by the program, many of them older people with an array of health problems. The Congressional Budget Office predicts that nine million people will gain coverage through Medicaid next year alone. In many of the 26 states expanding the program, the newly eligible have been flocking to sign up.

Community clinics, which typically provide primary but not specialty care, have expanded and hired more medical staff members to meet the anticipated wave of new patients. And managed-care companies are recruiting doctors, nurse practitioners and other professionals into their networks, sometimes offering higher pay if they improve care while keeping costs down. But it is far from clear that the demand can be met, experts say.

In California, with the nation’s largest Medicaid population, many doctors say they are already overwhelmed and are unable to take on more low-income patients. Dr. Hector Flores, a primary care doctor in East Los Angeles whose practice has 26,000 patients, more than a third of whom are on Medicaid, said he could accommodate an additional 1,000 Medicaid patients at most.

“There could easily be 10,000 patients looking for us, and we’re just not going to be able to serve them,” said Dr. Flores, who is also the chairman of the family medicine department at White Memorial Medical Center in Los Angeles.


On top of that, only about 57 percent of doctors in California accept new Medicaid patients, according to a study published last year in the journal Health Affairs — the second-lowest rate in the nation after New Jersey. Payment rates for Medicaid, known in California as Medi-Cal, are also low here compared with most states, and are being cut by an additional 10 percent in some cases just as the expansion begins.

“The symbolism is horrible,” said Lisa Folberg, a vice president of the California Medical Association.

This is just one more nasty side-effect of Obamacare that was predicted by many of us while the legislation was up for debate, but – as usual – no one listened.   Instead, the response was that the government was going to come up with a way to encourage more people to become nurses, physicians, etc so that when all was said and done there would be no crisis in the medical community when it came to how many doctors would be able to serve the increasing demand that would come from Medicaid patients as a result of the regulations contained within Obamacare.  There will be no shortage of doctors, they said, because the government was going to provide incentives for existing doctors to keep their practices open and opportunities for aspiring doctors to continue on their path towards becoming one.

It hasn’t happened.

To further muddy the waters, left wing activists have tried to put pressure on doctors to keep their doors open, claiming that “true doctors” don’t practice medicine for the love of money but for the love of helping people. The reality of is that no matter the reason someone becomes a doctor, they need money to pay their bills -which includes the salaries of their medical staff, the costs of their facilities, equipment, day to day operations, etc – and to be able to live.

In other words, the promises from the government on predictions of doctors shortages were like so many other government promises – lies, and the guilt tripping by left wing activists towards doctors on their “true motivations” for starting a practice didn’t work. So here we are, with doctor shortages already negatively impacting patient care, and the future on this front looks very, very bleak.

Where do we go from  here?

Phineas Butts In: ST asks a good question about the growing number of doctors not accepting Medicaid, but, don’t worry; some Democrats already have an answer.

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