Original article https://www.benefitspro.com

By Kathryn Mayer

Medicaid is poised to expand in a big way — thanks to the Patient Protection and Affordable Care Act — but just who is going to treat those new patients?

That’s the major flaw of Medicaid expansion, according to new analysis from HealthPocket, a website that compares and ranks health plans.

HealthPocket’s research found that physicians across the board report low acceptance rates for Medicaid patients — and physician assistants and nurse practitioners are unlikely to fill the gap, raising the question of whether Medicaid expansion will simply leave more Americans insured but with no one to go to for their care.

Only 43 percent of doctors report that they currently accept Medicaid patients. At the same time, physician assistants and nurse practitioners — viewed by many as a potential solution to the primary care physician shortage — report that only 20 percent of them accept Medicaid.

Results of HealthPocket’s study were based on data from National Provider Identifier registry which included information self-reported by more than 1 million health care providers.

“Ensuring there are sufficient health care providers available to the newly insured — even those with private insurance — is a major public health challenge right now,” Kev Coleman, head of research and data at HealthPocket, said in a statement. “But if the current Medicaid acceptance rates hold true for 2014, timely access to care for those relying on Medicaid is likely to become more difficult as enrollees increase for an already inadequate pool of doctors.”

Historically, Medicaid payments to doctors have been lower than payments from both private insurance and Medicare despite being for the same service. According to the Kaiser Family Foundation, Medicaid pays doctors only 66 percent of the amount Medicare pays for the same service.

PPACA includes provisions to raise reimbursements rates of Medicaid compared to Medicare and other plans, but those have not fully been implemented and offer only a temporary two-year increase.

Previous reports also have found that physicians are hesitant to accept Medicaid patients, but HealthPocket’s survey is different because it also examines Medicaid acceptance rates for PAs and NPs, potentially signaling a greater problem than initially thought.

That’s already on top of a continuing — and growing — doctor shortage. The Association of American Medical Colleges predicts there will be a shortage of 90,000 doctors by 2020, half of whom are primary care physicians. The influx of new patients under PPACA will have profound implications for patient access to medical care, doctor groups have warned.

Many states have been struggling with whether not to expand Medicaid, the government health insurance program for the poor, despite the fact that the federal government will pay the full cost of the new enrollees for three years, and much of the costs thereafter, under health reform. Though the administration had intended for the expansion to be mandatory, the Supreme Court ruled last year that states could opt out, leading many Republican governors to do so.

A recent Gallup report also signaled challenges and costs ahead for an expanded Medicaid program: The research found that Medicaid patients are significantly worse health than those with employer-sponsored coverage.

A third of Medicaid patients are obese, while another 22 percent are being treated for depression and 24 percent are being treated for high blood pressure, according to the latest Gallup-Healthways Well Being Index. Medicaid patients are also more likely suffer from diabetes and asthma.

Some researchers worry that those who most need treatment simply won’t be able to access it.

“No matter if you live in a city with a high or low average income, finding a Medicaid provider is a challenge,” Coleman said. “New Medicaid enrollees are going to have to do some digging to make sure they can find a doctor or another type of practitioner willing to see them and accept these reimbursement rates.”