- 83 Percent of NC doctors are at full capacity or already overextended
- 79 NC counties are designated as “primary health professional shortage areas”
- Medicaid expansion would overwhelm the medical system; coverage would not equal care
Proponents of expanding North Carolina’s already overcrowded Medicaid program have long mistakenly equated insurance coverage with access to medical care. Adding to this chorus is Gov. Roy Cooper’s Secretary of the Department of Health and Human Services Mandy Cohen.
During a February meeting of the North Carolina House Health Committee, Cohen was asked about the issue of improving access to care in the state. She said:
“If you really want to care about access … we have to think about using Medicaid to get more folks coverage. If we’re really going to help folks get access to care in rural areas, having an insurance card and keeping those access points open is going to be really critical.”
Where Cohen’s statement goes wrong, however, is how it equates having an insurance card to the ability to actually access medical care.
For starters, North Carolina Medicaid has added a million enrollees since 2003, at a time when the number of physicians accepting Medicaid patients has dropped by more than 1,300.
Further undermining the “coverage equals access” narrative is an acute shortage of North Carolina doctors in rural areas – which are areas with higher percentages of Medicaid enrollees and potential enrollees under Medicaid expansion. Indeed, 70 of 80 rural counties in North Carolina are currently designated “medical deserts” for their lack of primary care availability, while 79 counties are designated as “primary care health professional shortage areas.”
Not only is there a rural doctor shortage, but doctors overall in North Carolina are largely at full capacity. In a 2014 survey conducted by the North Carolina Medical Society, 83 percent of North Carolina physicians said they were at “full capacity” or “overextended and overworked.”
With regards to Medicaid patients, 29 percent said they either “limit” the number of these patients or do not see them at all.
Moreover, 42 percent of respondents said they will “accelerate” their retirement plans because of changes to healthcare and medicine.
Walker Ray, MD, vice president of The Physicians Foundation observed, “These trends carry significant implications for patient access to care. With more physicians retiring and an increasing number of doctors — particularly younger physicians — planning to switch in whole or in part to concierge medicine, we could see a limiting effect on physician supply and, ultimately, on the ability of the U.S. healthcare system to properly care for millions of new patients.”
The physicians’ survey provides more evidence that health coverage does not equal access to care. Adding 500,000 enrollees to the state’s Medicaid program will generate significant demand for medical services. But doctors who are already at full capacity or overextended won’t be able to meet that demand.
And with nearly a third of North Carolina doctors saying they limit their Medicaid caseloads or don’t see Medicaid patients at all, it is difficult to imagine any result from expansion other than long wait times and diminished access for traditional Medicaid populations because of the influx of new enrollees.
With such limited access to doctors, Medicaid enrollees inevitably resort to the more-costly emergency room for care. A 2017 study published in the Annals of Emergency Medicine journal concluded that emergency room “use per 1,000 population increased by 2.5 visits more in Medicaid expansion states than in non-expansion states,” and that increases in such visits were largest for “states with the largest changes in Medicaid enrollment.”
Unfortunately, ER’s are not prepared for this new influx of Medicaid patients. A 2015 survey by the American College of Emergency Physicians found that “70% of member physicians believe their emergency department is not adequately prepared for potentially substantial increases in patient volume.”
Contrary to Secretary Cohen’s comments, a Medicaid insurance card will not magically translate into access to care.