Primary care capacity in 2014

Over at The Atlantic, Avik Roy laments Why Obamacare’s Medicaid Expansion Will Reduce Health Care Access. His main point? Medicaid reimbursement is too low to increase the supply of physicians in the program. He cited a recent study from Chapin White on CHIP (not the ACA). From the abstract:


The findings suggest that (1) coverage expansions, even if they substantially reduce patient cost sharing, do not necessarily increase physician utilization, and (2) increasing the generosity of provider payments in public programs can improve access among low-SES children, and, through spillover effects, increase higher-SES children as well.

Roy focused on the former but never mentions the very important boosts to primary care reimbursement in the ACA, including a 10% bonus in Medicare and an increase in Medicaid primary care rates to at least Medicare rates starting next year. Not to mention the other workforce development efforts in the ACA, like enhanced reimbursement for medical homes, scholarships for primary care and funds for FQHCs.

Clearly we have issues with the medical workforce, but the ACA really did address some of these issues head on. Whether is it sufficient remains to be seen, but Roy’s critique misses the key point.


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