Short Takes On News & Events

States’ Medicaid Decisions Leave Health Centers, Patients In Lurch

By Phil Galewitz

May 9th, 2014, 2:21 PM

More than 1 million patients who use federally funded community health centers will remain uninsured because they live in one of 24 states that chose not to expand Medicaid under the Affordable Care Act, according to a study released Friday by researchers at George Washington University.

Most of those patients live in the South, because every state in that region except Arkansas and Kentucky opted against expanding the federal-state program for the poor after the Supreme Court ruled in 2012 that it was optional.

“These low-income patients already face significant challenges to obtaining health care,” says lead author Peter Shin, director of the Geiger Gibson Program in Community Health Policy at George Washington University. “Our analysis suggests these patients will remain without access to affordable insurance, which will almost certainly lead to delays in care and the risk of more serious health conditions.”

Health centers in states that have expanded Medicaid are benefiting, as 2.9 million of their uninsured patients were projected to gain coverage in 2014 either through Medicaid or through buying subsidized private coverage on the new health insurance marketplaces, the report found. Officials at health centers in Colorado, Kentucky and other states that expanded Medicaid have seen their rates of uninsured patients fall dramatically this year.

Gaining coverage helps health center patients get access to specialists along with prescription drugs, diagnostic tests and hospital care for little or no out-of-pocket costs. The coverage will also be a financial bonanza for health centers that are paid several times more from Medicaid than from the sliding scale fees they charge the uninsured.

Nationally, about 1,200 community health centers provide primary care services to nearly 21 million patients at 8,000 sites. About 36 percent of their patients in 2012 were uninsured and 39 percent were on Medicaid.

In the states that expanded Medicaid this year, the government and private insurance payments will generate potential revenues of $2.1 billion in 2014 for the centers. That’s money the centers can use to pay for physicians, nurses and to expand services. But in the states that opted against expanding Medicaid, the centers will lose about $569 million in extra Medicaid funding, the study found.

Health centers in nonexpansion states are unlikely to have money to grow and “as a result, access problems are likely to increase as the number of uninsured patients who seek care at health centers increases,” the report said. And this is likely to exacerbate existing access problems, particularly in the South.

The report showed that 35 percent of the 1.1 million community health center patients left struggling without insurance live in just five states —Alabama, Florida, Georgia, Louisiana and Mississippi.

“That is a huge resource loss for them,” Shin said.

If all 50 states had expanded Medicaid as the law’s framers had intended, 5.2 million uninsured community health center patients out of a total of 7.5 million would have been covered, the report projected.  Those that would have remained uninsured could not afford to buy coverage on the exchange, chose not to purchase it or were ineligible for Medicaid because of their immigration status.


5 Responses to “States’ Medicaid Decisions Leave Health Centers, Patients In Lurch”

  1. Randy says:

    America continues to hold the record in healthcare spending. No other nation on earth spends 18 percent of GDP on healthcare. Americans are stooges. Americans will continue to be stooges until we do like every other industrialized nation on earth. Eliminate private insurance and move as quickly as possible to a single-payer government run public healthcare system. Every other industrialized nation on earth made that move decades ago. They were smart. America continues to be stupid.

  2. R. E. H. says:

    The single-payer model is hardly a panacea. It would have virtually no impact on shortages of clinicians related to increased demand resulting from an expansion of coverage.

  3. Utah Jim says:

    Hey R.E.H.,

    I suggest you do a web search for…

    “What Surge? Nation’s Primary Care System Holding Up Well So Far Under Obamacare”

    Who knows?

    You might learn something other than the talking points you get from Rush…


  4. Wanda B. says:

    Utah Jim – I’ve read that article. While there hasn’t been a massive surge so far, the article notes that some states have seen major increases in locals seeking care that have put a strain on limited hospital staff. Further, it suggests that because so many (nearly 1 million) of the individuals who have qualified for Medicaid still have yet to receive their cards and thus probably aren’t currently seeking medical care, we don’t yet know what a potential surge will look like. Add one million individuals to the mix and things might change.
    There IS a shortage of primary care physicians in this country. Hospital executives know this, medical schools know this, and the doctors certainly know it. And payment systems for which the ACA advocates (bundled payments, the ACO model, and pay-for-performance reimbursement) certainly aren’t providing incentives for anyone to become a physician. While these might certainly be more affordable for the patient, PCPs aren’t thrilled, and that’s something we need to remain aware of.

  5. Sidney says:

    Wanda B.,

    I’ve been seeing the same PCP for decades. His well worn story about his profession is that about 85 percent of his daily routine could easily be done by a PA or an RN. The other 15 percent of cases usually are referred to a specialist. Removing warts and giving flu shots do not require a doctor’s training. Cuts and bruises and sprained ankles do not need the kind of expensive training that doctors must achieve in medical school, let alone the training doctors need just to maintain their license. Do we really need doctors doing ordinary triage? My experience in the military says we could have “enlisted” personnel doing that work. In the military, it was a rare occasion that you would see a doctor on an initial visit to sick bay. The very first person your would see, in the military, was a medically trained enlisted person. In civilian life…that’s a nurse!