One of the pushes of health care reform ideas for the last decade or more has been to get everyone “covered.” The key provisions in the Affordable Care Act are aimed at getting more Americans covered under health insurance. We got to the point where health care and health insurance coverage were used interchangeably as if there were no way to get any care without having insurance.
Assuming for a moment that the law succeeds in getting more people insured, it may not accomplish the spoken goal of getting more care for more people, even if they have insurance:
A survey of physician practices in 15 metropolitan areas across the country, which was taken before the health law expanded coverage, found that the average wait time for a new patient to see a physician in five medical specialties was 18.5 days. The longest waits were in Boston, where patients wait an average of 72 days to see a dermatologist and 66 days to see a family doctor. The shortest were in Dallas, where the average wait time is 10.2 days for all specialties, and just five days to see a family doctor.
The bad news is that fewer doctors are accepting Medicaid: An average of 45.7 percent of physicians surveyed take Medicaid coverage, down from 55.4 percent in 2009. Acceptance rates varied widely, however, ranging from 73 percent in Boston to 23 percent in Dallas. An average of 76 percent of physicians surveyed accept Medicare.
Note two things here. First, note that fewer than half of all physicians accept Medicaid. Most of the newly insured in the first few months of PPACA are insured under Medicaid, and there will be few doctors taking the patients even now that they’re “covered.” Second, note the wait times in the first paragraph. The longest by far are in Boston, where they have had a state-run version of PPACA since 2007, in a state with one of the highest insured rates in the USA. Note also that the city with the lowest wait time to see the doctor is the same city with the lowest acceptance rates for Medicaid. The better doctors are compensated (Medicaid is a low payer) the more doctors there are to see patients.
Getting more people covered may actually reduce access to care, especially for the poorest among us. When trying to solve a problem, always watch out for unintended consequences, and consider how incentives move the systems you’re affecting with the “solution.”