• 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.


    • I continue to wonder why the answer to a shortage of physicians is not to train more and import more. This would clearly increase overall supply (and should lower price).

      Shifting physicians from various specialties to primary care would increase the supply of primary care physicians (and therefore should lower price), but would decrease the supply of the specialists (with the opposite effect on price).

    • @foosion…..These are very good points you mention but with 80 million seniors turning 65 over the next 20 years the last thing our country needs is a shortage of specialists. As a Quality Development Specialist at a health insurance consulting firm, I deal with individuals on Medicare and/or Medicaid every day. I think it’s a great idea to import physicians from other countries who 1) are lookin to establish their practice here in the states and 2) are willing to accept a lower reimbursement rate. The only problem is that a large percentage of these seniors do not want to go to a physician they cannot understand or communicate clearly with. This is understandable considering it is their health we are talking about. However, I was mulling over an idea I came across the other day. My sister is in Medical school right now, as are thousands of other students, who I’m quite sure will have hefty loans to repay once they graduate. What if the government were to forgive those loans as long as these Medical students, now professionals in their selected fields, accepted the Medicare/Medicaid reimbursement rates for say the next 15-20 years.
      By doing so, the government can ensure that Medicare/Medicaid beneficiaries will always have physicians to go to. There will be an ever changing list of physicians willing to accept these lowering reimbursement rates because they too want to establish their practice and have their loans forgiven. It is also a win win situation for the seniors as well because they are now able to see physicians they can communicate clearly with.

      • Well, England does it with 50-50 primary care/specialists.
        Shouldn’t the USA do similar to save costs and still provide quality care?

    • -Isn’t the Medicaid reimbursement increase only funded through 2016?

    • The increase in Medicaid reimbursement is temporary, 2 years only. It also only applies to a subset of services. So even if the increase is sufficient to convince more docs to accept new Medicaid patients, it goes away after 2 years, so we’ve either created a new “doc fix” situation that will increase the cost of the bill, or the increase will go away as planned and access will be reduced again.