Can health providers handle influx of newly insured?
On the morning after Sunday's vote to revamp the health care system, Bob Caulk contemplated the enormous task of extending health care coverage to the nation's millions of uninsured.
Caulk, chief executive officer of The Effort, spoke enthusiastically about expanding his nonprofit chain of clinics, based in midtown Sacramento, into more places.
"We're going to be ready, and other clinics are trying to gear up," Caulk said. "The question is: Where are you going to put all these people in a system that's not yet designed to accommodate them?"
Across the country, as many as 32 million of the country's 46 million uninsured could soon have improved access to affordable health insurance – through government subsidies or by becoming eligible for Medicaid programs such as Medi-Cal.
Whether the system will be ready to receive them remains a significant unknown. The influx of new patients may strain the nation's supply of primary care physicians. But at the same time, it could ease the burden on county clinics and emergency rooms, which currently provide care to those who lack insurance. Community clinics like The Effort could step up to serve more people.
Physicians groups have raised concerns about whether there will be enough primary care doctors to serve all the new subscribers.
"It's a big question," said William Sandberg, executive director of the Sierra Sacramento Valley Medical Society.
The medical society posed that question to 531 of its members in January, and the response was a resounding "no."
In California, more than 8 million people lack health insurance. According to a Bee analysis of U.S. census data, that number includes one in six Sacramento County residents.
"Our members expect that we will have a shortage of primary care physicians," Sandberg said.
Nicole Kasabian Evans, spokeswoman for the California Association of Health Plans, agreed. "The provider side is a big issue," she said. "There has to be a good supply of primary care providers out there."
A key focus of the legislation is to promote early visits to primary care doctors to save the system from expensive surgeries, complications from chronic diseases and other advanced illnesses. But medical schools have been producing fewer primary care physicians, with many students opting for more lucrative specialties that will allow them to pay back school loans.
Primary care physicians have long complained about meager reimbursements from government health programs, such as Medicare and Medicaid, known in California as Medi-Cal. Despite an expected boost in funding for Medicaid included in the federal legislation, it won't be enough to entice doctors to accept more of those patients, says the California Medical Association.
Still, some experts say fears of a big shock to the health care delivery system are likely overblown.
It's not as if the uninsured would all come rushing at once for medical coverage, said Marian Mulkey, a senior program officer with the nonpartisan California HealthCare Foundation.
While some parts of the federal legislation, once signed by the president, could be implemented as soon as this year, most of the major provisions won't come on line for another three years. "There won't really be a sea change until 2014," Mulkey said.
"It's not as if all 32 million will get insured in the first possible year," she said.
The health care legislation could ease the strain on some parts of the medical system, even as demand for services increases.
The expansion of eligibility for Medi-Cal could remove thousands from the county medically indigent program.
Sacramento County officials, slammed by budget cuts, have been examining how the federal legislation could affect the county's obligation to provide services to the county's 42,000 medically indigent, said Laura McCasland, a spokeswoman for the county's Department of Health and Human Services.
"It's too early to know how this will affect services," she said.
Many of the newly insured could get services at community clinics like The Effort. As much as $11 billion in federal funds could be distributed to federally qualified health centers to help them expand services.
As more people get insurance, hospitals expect an easing of emergency room visits by the uninsured. But the problem is unlikely to go away completely, said Scott Seamons, a regional vice president for the Hospital Council of Northern and Central California.
"I know there are a lot of questions about how all this will bear out. But I do believe that hospitals are positioned well," Seamons said.