Will Medicaid push us into a single payer system?

Fewer Doctors Enrolled in Low-Income Insurance Program Despite Surge in Patients

By Hannah Guzik
California Health Report, July 14, 2014

Nearly 25 percent fewer physicians were signed up to treat low-income patients in the state’s insurance program this spring compared to a year prior, despite the surge in patients enrolled in Medi-Cal.

The drop in providers is due to the Department of Health Care Services’ efforts to remove doctors who haven’t complied with application requirements or billed the program in a year, spokesman Anthony Cava said.

“This has not resulted in a decrease in access to care,” he said.

More than 2 million people have signed up for Medi-Cal, the state’s low-income health plan, since the program was expanded under the Affordable Care Act. In total, 10.6 million people are enrolled — a quarter of the state’s population.

An additional 600,000 people are still waiting for the state to process their applications.

About 109,000 physicians were enrolled in Medi-Cal last spring, according to the Health Care department. But by this May, that number had dropped to 82,605.

Of the doctors enrolled in May, 38,845 were primary-care providers and 43,760 were specialists.

On its own, the agency’s list of providers isn’t necessarily a reflection of whether Medi-Cal patients have sufficient access to doctors. The list doesn’t specify whether the doctors are accepting new patients or how many they can accept, Cava said. While some doctors on the list may have up to 2,000 Medi-Cal patients, others might see only a handful or none.



By Don McCanne, MD

Medi-Cal, California’s Medicaid program, serves as an example of the consequences of using Medicaid to expand coverage for the exceptionally poor. After the backlog of applications are processed, over 11 million people will be enrolled in Medi-Cal - about 29 percent of the state’s population. At the same time, 25 percent fewer physicians will be listed as Medi-Cal providers (a result of culling, not voluntary disenrollment). Further, many of the physicians enrolled already limit or exclude Medi-Cal patients from their practices. We should learn soon what impact this will have on access, and the news will not be good.

California has the additional problem that it has the lowest per patient Medicaid funding, with an additional 10 percent reduction in payment rates - a Great Recession cut which Gov. Brown refuses to restore. Think of the options that physicians have when they are being paid significantly less than their overhead expenses for taking care of these patients. None of their options are very good.

The latest CBO projections (April 2014) indicate that nationally 48 million people will be enrolled in Medicaid and CHIP - 13 million more than would have been enrolled had the Affordable Care Act (ACA) not been enacted. The number of uninsured will be 31 million - a number that includes those who would have been eligible for Medicaid had their governors not refused to expand Medicaid in their states. As if access for Medicaid patients were not bad enough, access for the uninsured will be much worse.

As has been said here before, building on the current system, as ACA did, is the most expensive and one of the least effective models of achieving reform goals. The least expensive comprehensive model, and one that achieves the desired goals, is single payer.

Although progressives are tooting their horns about how well ACA is working, the Medicaid program is only one example of how miserably short we have fallen in our efforts to achieve a premier performing system. Put away the horns and get to work.