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Get Obamacare, While Supplies Last

July 12, 2013

By Paul Howard

With deadline near for buying new policies, little is being said about doctor shortage.

On Oct. 1, the uninsured can start signing up for coverage under ObamaCare. But should every policy be sold with an asterisk: Guaranteed access to care ... while supplies last?

Maybe. The unpleasant truth is that we don’t have enough doctors to offer quality care to a growing number of Americans, never mind the nearly 30 million uninsured who’ll begin to gain coverage under ObamaCare starting in 2014.

ObamaCare didn’t cause America’s physician shortage. Changing demographics and perverse reimbursements are the main culprits. But the law didn’t do much to address the underlying problems. Estimates vary, but the Association of American Medical Colleges predicts the U.S. will be short 130,000 doctors across all specialties by 2025. In fact, about one-third of all doctors plan to retire in the next decade.

Lack of access

Today, nearly 20% of Americans lack adequate access to primary care because there aren’t enough physicians. About 30% of doctors won’t accept new Medicaid patients. About one-third of ObamaCare’s insurance expansion will come through expanding Medicaid.

In a new report, Yevgeniy Feyman and I tried to gauge the effect of ObamaCare on the primary care physician shortage. ObamaCare relies on primary care providers to coordinate care in the hopes of lowering costs and improving outcomes.

After adjusting for population growth, aging and demand for care created by the newly insured, we estimate that by 2025, the U.S. will face a shortage of 30,000 primary care physicians, nearly 5,000 of which are attributable to the expansion of insurance under ObamaCare.

ObamaCare does contain some modest provisions to improve access. For instance, it allocates $1.5 billion for the National Health Services Corps, a scholarship program for students committed to providing primary care in communities with doctor shortages; allows unused residency slots to go to areas with care shortages; provides new funding for nurse education and training; and grants increases for two years in reimbursements for primary care providers in Medicaid to Medicare levels, which is still well short of what private insurance pays.

Inadequate steps

But these provisions are inadequate. Medicare grossly underpays primary care doctors compared with specialists and pays nurse practitioners 85% of what it pays doctors for the same services. And medical students are leaving school with crushing debt.

We need an all-hands-on-deck approach, starting with a new Medicare payment formula for doctors. To his credit, President Obama recommends this in his 2014 budget. We should also pay nursing practitioners the same as doctors when they provide the same services, encouraging more to enter the field.

Finally, the Federal Trade Commission should challenge anti-competitive state regulations that limit new business models, such as retail clinics, that can deliver high-quality services. These rules protect incumbent providers but hurt patients.

ObamaCare’s focus on expanding health insurance left many of our biggest access-to-care challenges untouched. Get ready for Health Care Reform 2.0, starting next year, when many of America’s newly insured realize that they have to get in line to see a doctor when they need one.

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