Last month the White House proudly announced that after completing the first year of Affordable Care Act (ACA) implementation the number of uninsured Americans is at historic lows-11.3% in the second quarter of 2014, down from 14.4% the year before. Over 10 million people enrolled for health insurance through Medicaid or an insurance exchange. But signing up for insurance does not equal access. Healthcare has to be available and affordable. The ACA did not achieve these goals in 2014 and 2015 will be worse.
Medicaid recipients have always had trouble finding care primarily because Medicaid pays physicians a fraction of private and Medicare rates. To remedy this the ACA included a federally funded two-year increase in Medicaid fees for primary care physicians up to Medicare levels. $5.6 billion was spent through June 2014. But the Urban Institute reports that it is unclear whether the increase in Medicaid primary care payment had an effect on the number of physicians accepting Medicaid patients, or on the number of Medicaid patients that physicians are willing to see. And increasing the fees of primary care physicians does not improve access to specialists-the Commonwealth Fund found that low Medicaid payment is the main barrier to specialty care. Most importantly, the primary care fee increase expired on December 31, 2014. The Urban Institute estimates this will lead to an average 42.8 % reduction in fees for primary care services. Since most states will not continue fee increases without federal funds, any increased access for Medicaid patients will not last.