Women’s health under the Affordable Care Act: What is covered?

A recent study reveals that almost one-third of physicians are no longer accepting Medicaid patients

If all states expanded Medicaid to cover people with incomes at or below 138% of the federal poverty level in 2014, as the Affordable Care Act (ACA) proposes, 23 million people would become eligible for the program.¹

That statistic prompts important questions:

• Would the health-care workforce be able to meet the demand of caring for all these new patients?
• Would it be willing?

A recent analysis of data from 4,326 office-based physicians suggests that the answer to both questions is “No”: Almost one-third of these providers were already declining to accept new Medicaid patients in 2011.²

Although 96% of physicians in the analysis accepted new patients in 2011, the percentage of physicians accepting new patients covered by Medicaid was lower (69%), as was the percentage accepting new self-paying patients (91.7%), patients covered by Medicare (83%), and patients with private insurance (82%).²

Physicians who were in solo practice were 23.5% less likely to accept new Medicaid patients, compared with those who practiced in an office with 10 or more other physicians.²

The data from this study come from the 2011 National Ambulatory Medical Care Survey Electronic Medical Records Supplement, a survey conducted by the Centers for Disease Control and Prevention National Center for Health Statistics. The survey included questions exploring whether physicians were accepting new patients.²

Earlier studies have found that the low reimbursement levels for care delivered through Medicaid has deterred many physicians from accepting patients.³

The view in the ObGyn specialty

The findings of this analysis were not broken down by specialty—only by primary care versus non–primary care. To get an idea of conditions in the ObGyn specialty, OBG Management surveyed the members of its Virtual Board of Editors (VBE). Of the 117 members contacted, 61 responded—a response rate of 52.1%. Roughly three-quarters (75.4%) reported that they currently treat patients covered by Medicaid, but only 60.7% are accepting new patients covered by Medicaid. Twenty-one percent of respondents reported that they have not and will not accept patients covered by Medicaid.

When asked to comment on their level of satisfaction with Medicaid, the most common response among VBE members was dissatisfaction due to “insufficient reimbursement.”

“I am not satisfied with Medicaid,” commented one VBE member. “The reimbursement is terrible….I have certainly thought of stopping care for Medicaid patients and, if Congress ever allows the big cuts to reimbursement that are threatened every year, I think I would stop.”

Another VBE member reported extreme dissatisfaction with Medicaid because of “lousy” reimbursement. He also pointed to “all the paperwork and crazy regulations that require inordinate time and additional personnel just to handle….and then [the claim] gets denied for reasons beyond reason.” He added that physicians who do accept Medicaid “are on the fast track to sainthood.”

Other reasons for refusing to accept patients with Medicaid (or, if Medicaid was accepted, for high levels of aggravation with the program):

• payment rejections
• too many different categories of coverage “that patients are completely uninformed about”
• difficulty finding a specialist who will manage high-risk patients covered by Medicaid
• red tape
• the complex health problems that Medicaid patients tend to have, compared with patients who have other types of coverage.

One VBE member summed up his feelings in one word: “Phooey.”

Several VBE members suggested that health reform should focus on the Medicaid program.

“These plans are just sucking up the state’s money and paying docs peanuts and their administrators big bucks!” wrote Mary Vanko, MD, of Munster, Indiana.

“I’m tired of how much Medicaid is being abused by people,” commented another VBE member. “People using other people’s cards, people with regular insurance getting Medicaid to cover their copays. The whole system needs reform!”

Some physicians were satisfied with Medicaid

Among the respondents were several who reported being satisfied with the program, including one who called the experience “good” and another who reported being “shielded from the reimbursement issues.”

“I have no problems with Medicaid,” wrote another.

—Janelle Yates, Senior Editor

References

1. Kenney GM, Dubay L, Zuckerman S, Huntress M. Making the Medicaid Expansion an ACA Option: How Many Low-Income Americans Could Remain Uninsured? Washington, DC: Urban Institute Health Policy Center; June 29, 2012. http://www.urban.org/UploadedPDF/412606-Making-the-Medicaid-Expansion-an-ACA-Option.pdf. Accessed August 18, 2012.

2. Decker SL. In 2011 nearly one-third of physicians said they would not accept new Medicaid patients, but rising fees may help. Health Affairs. 2012;31(8):1673–1679.

3. Centers for Disease Control and Prevention. QuickStats: percentage of office-based physicians accepting new patients, by types of payment accepted—United States, 1999–2000 and 2008–2009. MMWR Morb Mortal Wkly Rep. 2011;60(27):928.