May 6, 2014 in Opinion

Editorial: Physician shortage threatens Affordable Care Act gains

 

The Spokesman-Review Editorial Board

Members of The Spokesman-Review editorial board help to determine The Spokesman-Review's position on issues of interest to the Inland Northwest. Board members are:

The expansion of Medicaid accounts for most of the sign-ups under the Affordable Care Act, but will having an insurance card ensure that new patients will get in to see a doctor?

Even before the expansion, warnings were being issued about the shortage of primary care physicians and the number of doctors who refused to see Medicaid patients. The Medicaid reimbursement rate is typically about one-third lower than Medicare’s. The Affordable Care Act provided temporary funding to equalize Medicare and Medicaid reimbursement rates through the end of this year, but then what?

That’s what the Health Care Authority, which runs the state Medicaid program, is wondering. According to an Associated Press article, the Health Care Authority is considering a partnership with the University of Washington and the Washington State Medical Association to gather input on how much the temporary bump influenced doctors to accept Medicaid patients. The results would be presented to the Legislature before the next session.

Research published last year in the Journal of the American Medical Association presaged this dilemma. Study author Dr. Renee Y. Hsia said, “A lot of people make the assumption that once someone is insured, they will automatically get access to a primary care physician.” She notes that about 30 percent of physicians nationwide won’t see Medicaid patients because of low reimbursements.

One of the goals of the Affordable Care Act was to redirect people from emergency rooms to primary care settings, where they would establish a pattern of seeing physicians before health care issues became urgent. But the U.S. health care system has an imbalance of physicians in specialties vs. primary care. A U.S. Senate report highlights the problem:

• Fifty years ago, half of doctors practiced primary care. Now, less than one-third do.

• About one-quarter of primary care physicians are nearing retirement age.

• In 2011, only 7 percent of medical school graduates chose primary care, which generally pays less.

Washington has about 6,000 primary care physicians. In 2012, the Office of Financial Management studied whether that was enough to handle the ACA expansion, but didn’t reach a definitive conclusion. Washington officials estimated about 120,000 new Medicaid enrollees from the Affordable Care Act, but the actual figure is closer to 300,000.

So it’s fair to ask, where will all these new patients go?

If they return to urgent care settings, it would undercut one of the presumed gains in expanding health care coverage. The easy answer would be to permanently equalize Medicaid and Medicare funding, but that would be expensive.

On the other hand, the government, through Medicare, finances residency slots for medical school graduates. Half of patient visits are to primary care doctors, but new graduates are increasingly pursuing higher-paying specialties.

There is no simple short-term answer to low Medicaid reimbursements, but government could improve the long-term outlook by focusing education aid where it’s needed most: the front lines.

The third paragraph of this editorial has been edited to correct an error.


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