Even with Federal Health Care Reform, Some Patients Struggle to Find Access to Care

Sep 25, 2013

The problem of access to care for patients with government health plans like Medicaid will likely continue under federal health reform.
Credit Creative Commons/Flickr/The National Guard

The Affordable Care Act continues to roll out with the opening of something called a marketplace next week. That’s where people can shop for health insurance. Health care reform also expands Medicaid - the government-subsidized health plan for low-income people. Currently, many doctors in the Roaring Fork Valley and beyond don’t accept Medicaid patients because the plan gives providers a dismal reimbursement. As Aspen Public Radio’s Marci Krivonen reports, some doctors say the issue highlights a fundamental problem with the health care system.

The doctors at Aspen Valley Pediatrics say they’re the only physicians in Aspen who see patients with Medicaid. That’s according to Doctor William Mitchell who has practiced medicine in the Valley for nearly 30 years.

Mitchell says his clinic sees about half the patients with Medicaid in Aspen and Basalt. He says he does it because he’s a do-gooder, not to make money. In fact, he says it’s a bad business decision. Typically, when Mitchell sees a patient with Medicaid, his office will be reimbursed around $35. If he cares for a patient with private insurance, reimbursement is usually between $120 and $150.

"Having health insurance doesn’t mean you’re going to have access to care," says Nan Sundeen.

She heads up Pitkin County’s Health and Human Services Department. Her office is preparing to help people sign up for insurance.

"So, we may insure a whole bunch of people, but if the medical community doesn’t find a way to take Medicaid and take these insurances, we’re still going to have the same issues, where people have to go far away to get the medical care they need," she says.

About 800,000 people in Colorado don’t have insurance. So, over the next year, many may enroll in Medicaid. By 2016, the Colorado Health Institute estimates 146,336 uninsured people will qualify for Medicaid. In Pitkin, Eagle and Garfield Counties, an estimated 3591 people will go from living without insurance to depending on Medicaid. So, where will those people go for care?

Many of will likely head to Mountain Family Health Centers. Ross Brooks is CEO for the organization, which operate clinics in Basalt, Glenwood Springs and Rifle.

"I come at it from a different perspective, I actually think that a lot of individuals who get health insurance will have access to health care through Mountain Family Health Centers, my organization. And, that’s because we accept all patients agnostic to their insurance status, agnostic to their income and agnostic to whatever their healthcare needs are," he says.

The clinics are preparing to serve more patients over the next 10 years, partly because of the Medicaid expansion, which is set to roll out on January first. Brooks says they will also see more revenue.

"We typically get reimbursed better when somebody has health insurance than when they don’t have health insurance, so some reimbursement is typically better than little to no reimbursement."

Federally Qualified health centers like Mountain Family receive Federal dollars. And, the Affordable Care Act pumped even more money into them so they would be able to serve the country’s newly insured.

Conversely, private doctors’ offices don’t receive this kind of funding. So, even as health care reform moves forward, the problem of access to care will likely remain.

"In a rural area, like ours, physicians are hard-pressed, I guess you’d say, to make a living, for most of them," says Aspen Valley Hospital Interim CEO John Sarpa. 

He says low volumes of patients are a huge challenge for doctors with practices in the Roaring Fork Valley. He says a physician has to make sure they're not only providing good care to patients, but also operating a viable business. For a doctor, that often means being fastidious about what reimbursements he or she takes.

An increased number of Medicaid patients impacts the hospital too. Right now, Aspen Valley Hospital depends heavily on patients with private insurance plans, or those who pay cash. Sarpa says he thinks that may change.

"Generally, we are expecting to have lower reimbursements, we are expecting our revenues, therefore, to go down. By how much, we don’t know, we’re trying to think through that now," Sarpa says.

Revenues could go down, he says, if reimbursement rates go down, whether due to more people on Medicaid or the result of increased competition among insurance carriers. The new exchange will put more, and usually lower priced, plans on the market.

Doctor William Mitchell at Aspen Valley Pediatrics says he understands why many so doctors in the Aspen area don’t take Medicaid patients. Rent and employee’ salaries cost more here, than say, Denver and reimbursements from private insurance plans pay those costs.

When the Medicaid expansion rolls out next year, Mitchell says his practice won’t take more patients initially. He says he likes to do good, but he also needs to make a living.