Plan B Forum

On Wednesday 6 million people will begin to have coverage who didn't before

Got a source for that?

*65,472 had enrolled & paid; 69,606 had enrolled but not paid yet as of 12/24

(thru 12/11=45K total; assuming 52/48 private/Medicaid based on 11/30 totals); 1,700 = on 12/23 specifically

Additional
Enrollments
Not Broken Out
By State

"... Even before the Affordable Care Act kicked in, some patients had difficulty finding a doctor who would accept their coverage. This is especially true with Medicaid, where 30 percent of doctors are not currently accepting new patients. The problem is particularly acute in states that pay Medicaid doctors much lower rates than the Medicare program.




"There is a shortage of primary-care physicians," says Reid Blackwelder, president of the American Association of Family Physicians. "It's a crunch."

Leighton Ku, a researcher at George Washington University who has spent decades studying insurance expansions, remembers when he had to switch health plans a few years ago.

"When I came over to GW, I had to go find a primary-care doctor," he says. "The first five primary-care doctors said they were not taking new patients. And this is something that will happen in the exchanges too, where providers listed in directories will say that. This has been a traditional problem."

In other words, we're starting from a baseline where patients already face challenges finding doctors. The question about health reform, then, is whether it makes those challenges greater.

More broadly, Ku does expect a lot of confusion -- about which doctors patients can see, and who is covered by what insurance plan -- in the first days and weeks of 2014. That's true of any insurance expansion, he says, and has more to do with a really big change to the health-care system than an actual capacity issue.

"I remember many years ago being in Hawaii for a big Medicaid expansion," Ku says. "I was wandering around their Medicaid agency, and every telephone was ringing constantly because there were so many questions people had. Doctors had questions, insurers had questions, pharmacists had questions. Then it calmed down."

Massachusetts may offer the best proxy for understanding how the insurance expansion will go. Annual surveys by the Massachusetts Medical Society don't show an especially clear pattern on access to care. There has definitely been a big drop in internists accepting patients, from 66 percent in 2005 to 45 percent this year. The wait time to see an internist has bounced around a lot, showing no clear pattern related to the state's insurance expansion.



But at the same time, there's been an increase in ob-gyns taking on new cases (from 71 percent in 2005 up to 84 percent today.)



Jha, the Harvard professor, has explored the Massachusetts expansion from a different angle. His research, published in the journal Health Affairs, looked at Medicare patients' access to primary care. He and his colleagues were trying to see whether the insurance expansion, bringing millions of new patients coverage, made it more difficult for the elderly to access their primary-care doctor.

They found no change; seniors had just as easy of a time getting in to see their doctors after the expansion as they did before. And they didn't experience any declines in their quality of health care, either.

"The big picture is that we really see no impact whatsoever on access to care or quality of care for everyone else," Jha says. "That is certainly the case for Medicare beneficiaries."

Jha thinks that part of the explanation is the health-care system having more capacity than we give it credit for, meaning that doctors have the space to fit more patients into their schedules. "One of the things that's a fallacy is that there's a fixed amount of care the population needs," Jha says. "That turns out not to be true. If doctors have lots of open slots, they'll see patients more. But if you don't see them, they'll probably wait six months and be fine."
...
"What will happen then, on that summer day when the federally insured system of paying hospital bills becomes reality?" Nona Brown, a New York Times reporter, wondered in a story published April 23, 1966. "Will there be lines of old folks at hospital doors, with no rooms to put them in, too few doctors and nurses and technicians to care for them?"

MedicareClip3

What happened was, well, not much. "Medicare takes over easily," was the headline in the Washington Post on July 2, 1966. "It was a smooth transition," Dan Morgan and Martin Weil wrote, describing the local scene as "undramatic."