For the Vulnerable, Expect Less Access to Care

At the Health Affairs blog, there is affirmation of a point that is rarely made outside of this blog: Access to care for the most vulnerable populations is going to go down, not up, under Obama Care. This is Anthony Keck, director of the South Carolina Medicaid agency for Governor Nikki R. Haley:

With expansion of coverage in the private sector – under an individual mandate or otherwise – … [A] large number of the previously uninsured will become covered under commercial plans that will almost surely pay higher rates than Medicaid. The economically rational decision for providers, especially those without a specific safety-net mission, will be to shift their attention from Medicaid patients to more generously reimbursed commercially insured patients. These providers will no longer have the financial imperative to be as affordable or convenient to patients with a Medicaid card.

When this happens, traditional safety nets can expect to see a greater share of the total Medicaid population and the remaining uninsured. This is happening in Massachusetts as emergency room visits have increased and safety-net providers such as community health centers report large increases in Medicaid patients in general.

Federal health reform extends the Massachusetts dynamic nationally. Not only will providers shift away from the current Medicaid population; the new Medicaid expansion population will arrive with many fewer providers to serve them. If Massachusetts is feeling these effects with a high number of primary care doctors per capita and a small uninsured gap to fill, imagine the problem facing South Carolina and others states which have the opposite problem – too few primary care doctors and too many uninsured.

Comments (7)

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  1. Tom H. says:

    Excellent point. And you are right. We mainly only see it made at this blog.

  2. Devon Herrick says:

    It is a safe bet that if there were only a few Medicaid enrollees, most doctors would consider it a charitable act to treat them alongside other patients. But when half the country has public coverage paying below-market rates, treating publically insured patients diverts more time and resources away from more lucrative patients. Plus if a sizable portion of publically covered enrollees don’t fall into the category of needy, the doctor probably feels less empathy to treat them.

  3. Marvin says:

    The ones who need help the most are so often voiceless. How many will be cut off from care and how will we know about it??

  4. Linda Gorman says:

    Judging from what goes on in the other countries that have variants of ObamaCare in place, lots of people will be denied care and no, we will not know it. In fact, government will work hard to make it impossible to keep track.

    We already know that Medicare allocated billions away from the seriously ill to the relatively healthy via its risk adjustment methods.

  5. kimberly rogers says:

    I went to Doctor Alberto Coto Calvo at High Tech Dental Clinic just outside of san jose Costa Rica.
    This man broke my tooth, causing 3 root canals to be preformed while under his care. He left me with 10 open margins ( the crowns are popped off the teeth ) and most importantly, he screwed up my bite so badly that I now suffer from severe TMJ, constant pain, can’t eat or speak properly etc…
    He refused to refund the small fortune that I paid him and he refused to pay to fix the dentistry that he botched.
    The cost to fix my bite alone is $35,000 ( which I don’t have ) plus thousands more for additional root canals that I still need because of his neglegence.
    I was threatened, almost charged with a felony and put in a Costa Rican prison for complaining about my botched dentistry publically.
    This story gets much worse. To see all the details you can watch my video under “warning medical tourism nightmare in san jose costa rica ” under my home page at

  6. Jersey Bill says:

    All excellent points made above, and there are so many more unexplored – or yet to be known. My being naive is showing, but you’d think “intelligent minds” (?) would prevail BEFORE it gets to the Supreme Court. The many pitfalls and problems should be known to them prior to any decision. With pessimism, it seems the SCOTUS will side with the government. The needy need help, but all of us will feel the negative effects of this act if it’s upheld.

  7. Rebecca says:

    I know many physicians who are increasingly avoiding Medicaid patients due to the regulatory death grip that ensues when they are part of your practice. (Some) private insurers or direct pay allow you to be more nimble in what kind of services you offer patients and how.