Physician groups have raised concerns that the expansion will overwhelm their ability to meet the new demand for care. That appears to be supported by some research. In a 2012 study based on CDC survey data, National Center for Health Statistics economist Sandra Decker concluded that only two out of three primary-care physicians would accept new Medicaid patients. That February study, published in the journal Health Affairs, concluded that up to 7,000 more primary-care physicians would be needed nationwide to meet the demands of the projected 29 million people who will gain coverage in 2014 through the federal healthcare law.
The new research—also led by Decker and published online this week by JAMA—indicates an increased load is coming to available physicians. The CDC researchers anticipate that at the time they enroll, the newly covered Americans will have an “intensive need for medical care” due to their untreated health conditions. About 35% didn't seek care within the last year, and 46% lacked a regular healthcare provider.
The researchers found other evidence suggesting the new Medicaid beneficiaries are likely to flood primary-care providers even though they're generally healthier than current enrollees. Among the uninsured population, 11% used hospital emergency departments for “routine care,” compared with 5% of Medicaid beneficiaries. “For the uninsured, it likely is tied to their being less likely to have a usual source of care that's in the community, a place they can go for their primary care, and there's likely a connection there,” said Genevieve Kenney, a senior fellow at the Urban Institute and one of the study's authors.
The somewhat encouraging findings regarding the health status of the new patients did little to allay primary-care physicians' concerns about the surge.
“I for one am not breathing a sigh of relief, saying 'We don't need to worry anymore about a workforce shortage,'” Dr. Molly Cooke, president of the American College of Physicians, said about the new research. “We still do.”
One way that policymakers have hoped to mitigate the expected onslaught of both new Medicaid enrollees and another 7 million gaining private insurance exchange coverage is by enticing more physicians to accept Medicaid patients by boosting primary-care pay rates. Medicaid programs pay 59%, on average, of what Medicare pays for primary-care services, according to a December Kaiser Family Foundation report.
“Before parity, you could not make ends meet, pay your overhead and keep your office doors open by accepting new Medicaid patients because the payment was inadequate,” Dr. Reid Blackwelder, president-elect of the American Academy of Family Physicians, said in an interview. “So very few practices were expanding their Medicaid rolls, and these were patients who would then have no source of care.”
The increase, authorized by the Patient Protection and Affordable Care Act, aims to boost Medicaid primary-care pay rates to Medicare levels for 2013 and 2014.
But the federal government and states have lagged in implementing that pay boost, which will be retroactive to Jan. 1. As of June 20, the CMS has approved 49 state plan amendments to implement the boost, according to an agency spokeswoman. California's is still pending.
“These are patients that require significant resources often and the boost just has not yet happened” for many physicians, Blackwelder said.
The delayed pay boost has similarly put off states' collection of required data tracking physician participation and primary care utilization in 2013 and 2014 and whether it increased from 2009. Such data may eventually be used to push for making the federal primary-care pay boost permanent or expanding it to include other medical care where there are access problems.