Empty Promise? Experts Question Doctor Supply to See California's Newly Insured Poor

By Emily Bazar, CHCF Center for Health Reporting

In less than one year -- Jan. 1, 2014 -- Obamacare’s promise to bring health care to perhaps 1 million more poor California residents will be tested. That's when Medi-Cal, the publicly funded health program for the poor and disabled, launches a huge statewide expansion.

But making a promise is one thing, and delivering is another.

In some places, it’s already tough for many poor California residents to find a doctor who is able –- or willing -- to see them when they need one.

From the sprawling Los Angeles basin to the sparsely populated rural north, many medical providers who currently see these patients say they are overwhelmed, a situation that could worsen when those newly covered by Medi-Cal arrive for care.

The epicenter is California’s Central Valley, where high rates of uninsured residents, coupled with persistent doctor shortages, create a potentially combustible brew that could thwart the success of the health care law.

“We’re not even talking about 2014,” said Carmen Burgos of the Greater Bakersfield Legal Assistance program. Burgos helps low-income Kern County residents access health care and dental services. “Good luck finding a doctor who takes Medi-Cal now.”

Progam Expansion

More than 7 million Californians are currently covered under Medi-Cal, and expanding the program is a major piece of President Obama’s health care overhaul, called the Affordable Care Act.

Between 2014 and 2019, roughly 1 million to 1.4 million more Californians will enroll in Medi-Cal as a result, according to UCLA and UC Berkeley estimates.

The Medi-Cal expansion will broaden eligibility by allowing applicants with higher incomes and allowing those who were previously ineligible, such as childless adults, to get coverage.

State officials say that there’s sufficient access to Medi-Cal services and that they are constantly monitoring to ensure that recipients can get care.

“We do believe that the Medi-Cal provider network provides adequate access in California now,” said Norman Williams, spokesman for the state Department of Health Care Services, which administers Medi-Cal. The state also is “adequately preparing for 2014 and the expansion.”

But doctors and health care experts across California offer a starkly different portrait of access on the ground.

• “We’re experiencing provider shortages right now,” said Alex Briscoe, director of the Health Care Services Agency in Alameda County, home to the cities of Oakland and Berkeley. He sees pressure points across the entire county, from less-populated areas to denser communities. “Patients often wait months to get access to care,” he said.
• Desperate parents overwhelm phone lines at Riverwalk Pediatric Clinic, a private practice in Bakersfield, searching for doctors who accept Medi-Cal, said pediatrician Hasmukh Amin. About half of the practice’s 20,000 patients already have Medi-Cal. “We say no to 25 to 30 callers per day,” Amin said. “We cannot handle any more volume. We are maxed out.”
• In Los Angeles County, more than 1 million people –- about one-third of them on Medi-Cal –- were seen at 174 health clinics in 2011, said Louise McCarthy, president of the Community Clinic Association of Los Angeles County. When asked whether there will be enough doctors to serve the growing population of Medi-Cal patients, she replied simply, “No.”

Low Rates

Medi-Cal is California’s version of the federal Medicaid program, and the Golden State ranks poorly in doctor participation compared with other states.

Two studies, including one published in Health Affairs in August, show that 57 percent of California doctors accept new Medi-Cal patients. That’s the second-lowest rate in the nation after New Jersey. California’s neighbors, Nevada and Oregon, accept 75 percent and 80 percent, respectively.

The primary reason doctors don’t participate is financial, doctors themselves say. California has one of the nation’s lowest payment rates, ranking 47th of 50.

Ted Mazer, an ear, nose and throat specialist in San Diego, chairs the California Medical Association’s committee that focuses on Medi-Cal policy. He said doctors lose money providing care under Medi-Cal. For example, he said, Medicare, the federal health insurance program for people 65 and older, pays doctors about $76 for a regular office visit. One private insurance company pays about $71.

Medi-Cal? It pays $24, he said.

About six years ago, Mazer began limiting his participation in the program.

These low Medi-Cal rates are being addressed — temporarily at least — by Obamacare.

Starting this past January and lasting two years, reimbursement rates for many primary care services in Medi-Cal will jump to Medicare levels, funded by the federal government. In California, the change is dramatic. On average, fees will increase by 136 percent, according to the Kaiser Commission on Medicaid and the Uninsured.

“The payment increase is a significant incentive that we anticipate will help attract new primary care physicians to the Medi-Cal provider network,” said Williams of the Department of Health Care Services.