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.