All Obamacared Up and No Place To Go

This is a feature, not a bug:

Enrollment in Medicaid is surging as a result of the Affordable Care Act, but the Obama administration and state officials have done little to ensure that new beneficiaries have access to doctors after they get their Medicaid cards, federal investigators say in a new report.

The report, to be issued this week by the inspector general at the Department of Health and Human Services, says state standards for access to care vary widely and are rarely enforced. As a result, it says, Medicaid patients often find that they must wait for months or travel long distances to see a doctor.

Robert Pear of The New York Times writes that by 2016, an estimated one in four less well-off Americans will have been on the Medicaid rolls at some point during their lives. The Affordable Care Act mandates only that states provide adequate care for people on Medicaid, but somehow forgot to define the meaning of "adequate." To make it even more suspenseful, the public Medicaid program is now largely administered by private, for-profit insurers who, in the interests of the free market god, must also extract their fees.

In one state, the "adequate" waiting time for a sick Medicaid enrollee to see a doctor is as much as 60 days, Pear writes, while in other more humane places, two weeks is the acceptable norm. Regardless, few states ever bother to prosecute Medicaid providers who fail to uphold agreed-upon standards of care for the indigent. It's kind of the same rationale outgoing Attorney General Eric Holder uses for his failure to prosecute renegade bankers: with so few of them to begin with, the whole system would collapse upon itself if you dared punish anybody.

 The private insurance Medicaid contractors, wanting to stay in business in a bare-bones system, have also been known to deliberately falsify information on their so-called provider networks -- including the names of physicians who are no longer in business, who have already reached their quota of new Medicaid patients, or even those who've always refused to accept Medicaid patients. And in some cases, the providers listed are completely fictitious. Fraud? What fraud? 

It's not like the Obama administration couldn't have foreseen that physicians, who even before Medicaid expansion, were not accepting Medicaid patients. The reimbursements are much lower than what private insurers and even Medicare pays out. Although the Affordable Care Act provides for increased fees for physicians seeing indigent patients, these are only for the first two years of the program, like a bait and switch special introductory offer" for new cable subscribers. 

 There is also a chronic doctor shortage in the United States. There are too few medical schools training new doctors. The rural poor have more difficulty seeing a physician than the urban poor. From McClatchy Newspapers:

Of more than 1 million physicians, therapists and counselors nationwide, only 43 percent accept Medicaid, according to a new study by HealthPocket, a technology firm that compares and ranks health plans.

The situation varies by city. The study found that only 31 percent of caregivers accept Medicaid patients in Washington and Detroit, 36 percent in San Francisco, 42 percent in Philadelphia and San Diego, and 47 percent in Seattle.

“If the current Medicaid acceptance rates hold true for 2014, timely access to care for those relying on Medicaid is likely to become more difficult as enrollees compete for an already inadequate pool of doctors,” said Kev Coleman, the head of research and data at HealthPocket.

The lean physician workforce has prompted some states to try to expand the types of primary care provided by nurse practitioners, physician assistants and other non-physician medical personnel. But the HealthPocket study found that only 20 percent of physician assistants and nurse practitioners nationally accept Medicaid, less than half the rate of doctors and other providers.

But as Doctor Pangloss would say, it could always be worse in this best of all possible insurance- kludgey, exceptionally American worlds. At least the poor people who must wait weeks or months and crawl miles to see a doctor are lucky to live in states that actually are accepting Medicaid expansion. As a Harvard/CUNY research study shows, as many as 17,000 people are expected to die needlessly every year because they aren't even being afforded the right to wait in line and play the health care lottery game for the poor in the first place.

The richest country on earth not only boasts the greatest wealth inequality on earth: it's even divided its poor populations into subsets of misery depending on the party affiliation of their overseers.

Read more here: http://www.mcclatchydc.com/2013/05/13/191105/most-doctors-still-reject-medicaid.html#storylink=cpy