Accessible healthcare? No more than before, or worse.
John Goodman spells it out at Forbes.com:
By one estimate, 14 million people are newly insured because of the Affordable Care Act. In addition millions of others have more generous insurance, promising new benefits. So you might expect that doctors’ offices would be flooded with a host of new patients seeking more care than they had before.
It’s not happening.
To avoid the effects of the 2008 financial crisis, the recession, and the slow recovery, John Graham compared the latest estimates from the Centers for Disease Control and Prevention (CDC) with their survey from a decade ago. The result:
“The proportion of people of all ages with a “usual place to go for medical care” was 87.8 percent last year, the same as it was in 2002-2003. Further, 5.7 percent reported that they failed to obtain needed medical care due to cost last year, the same as it was in 2003-2004.”
[A possible explanation (noted by Graham) is that the percent of the population that is uninsured is not much different than it was a decade ago.]
Another study focuses on what happened last year – the first year of access to expanded Medicaid and the health insurance exchanges. New data from 16,000 providers across the country, collected by AthenaHealth, shows that requests for new appointments just barely edged upward in 2014. The proportion of new patient visits to primary care doctors increased from 22.6 percent in 2013 to 22.9 percent in 2014.
That was an awful lot of disruption to move the needle three tenths of a percentage point.
Why doesn’t it work? Perhaps a better question would be: Why would it work?
Goodman suggested one explanation that I think is quite interesting:
My own view is that the importance of health insurance has been enormously exaggerated by the health policy community. People without health insurance often find a way to get insurance when a family member develops a serious health problem. Even when they don’t, they often find ways of getting health care.
Other factors he mentions are ones we have posted about before. For one thing, people are self-rationing because, despite the exorbitant price of the insurance, their deductibles are too high for them to afford. The other factor is that, people are insured in theory but the networks are so small that doctors are often not available. You might as well be a former soldier trying to get an appointment with the VA—a comparison that Obama actually made when he was campaigning for Obamacare, I think.
This same problem is involved in all the people now enrolled in Medicaid.
On the other hand, those people who are newly insured through Medicaid, are in a health plan where access to care is notoriously bad. In fact there is some evidence that the uninsured have an easier time making a doctor’s appointment than people on Medicaid.
Goodman goes on to discuss the mental health industry.
Although an estimated 62 million patients now have better coverage because of the Affordable Care Act, a new report from the National Alliance on Mental Illness concludes that “patients with mental illness are no better off under Obamacare.”
Again, it is as bad or worse than trying to get on the real list for the doctor at a VA hospital.
A reader, Derek Dye, wrote to Goodman about his experiences:
“In the volunteer work I do at a free clinic in Arlington I’ve recently had the unfortunate task of trying to help evidently mentally ill patients find providers after being forced on the exchanges or Medicaid after losing their insurance, their job, or their access to the clinic, depending on their situation….”
“[W]hat I found even more troubling were the calls I was placing to providers who aren’t even real. I thought I was crazy or just calling the wrong offices as I was getting answering machines at gas stations and restaurants at numbers listed on Carefirst’s website as psychiatrists (this happened on multiple calls). In talking to the savvy receptionist she confirmed that this is not uncommon, especially in ACA plans….”
“[T]he providers I finally got through to were very obviously pill mills in this particular Carefirst plan per Yelp and public records of their prior run ins with the law.”
Let’s call it Bananarepublicare.