Once Obamacare is fully implemented in January, hundreds of thousands of Californians will move from the ranks of the uninsured to the insured. That's the good news. The downside: many California counties already face a shortage of primary care doctors -- a shortage that is especially acute in the Central Valley.
How those newly insured -- especially those who will be enrolled under Medi-Cal -- will access care is an especially pressing question in Kern County, as the CHCF Center for Health Reporting has been exploring under a series, Desperate for Doctors.
A chief problem is not only the shortage of primary care doctors, but also the question of whether physicians accept Medi-Cal patients. If individuals and families hold Medi-Cal insurance, but can't find a doctor who will accept it, their new coverage isn't much help.
A straightforward starting point would be to quantify how many doctors there are and how many accept Medi-Cal. But, in a great piece of reporting, Emily Bazar found that there's little agreement on these two critical pieces of information -- within statewide agencies.
The state's Department of Health Care Services (DHCS) report there are 2,023 Kern County doctors who see Medi-Cal patients, Bazar writes. Starting point, yes? But this number was a surprise to people on the ground in Kern County. From Bazar's report:
Here’s what Sandi Palumbo, executive director of the Kern County Medical Society, says:
“Whaaaattt!? I didn’t even know there were that many licensed physicians in Kern County."...
The state Medical and Osteopathic Medical Boards, in charge of licensing doctors who practice in California, show about 1,200 physicians in Kern County, more than 800 fewer than the state’s statistic.
A DHCS spokeswoman told Bazar that the discrepancy could be accounted for by doctors who are licensed in other counties, but practice in Kern. Palumbo didn't buy it.
Bazar reports that DHCS says there are 104,239 doctors statewide who are enrolled as Medi-Cal providers. But the California Medical Association doesn't buy that number, either. From Bazar's report:
Lisa Folberg, vice president of medical and regulatory policy for the California Medical Association ... says the state’s number is “ridiculously overinflated.” ...
She points to the number of doctors licensed by the state with addresses in the state: About 107,000.
Folberg said there’s no way that almost every doctor in the state accepts Medi-Cal. “Every study across the nation shows that not all physicians participate in Medicaid,” she said.
State officials again had an explanation for these conflicting numbers: there is currently no expiration date on a doctor's enrollment in Medi-Cal. But starting this month, the Affordable Care Act requires that state's confirm a doctor's participation in the program every five years.
Perhaps that 104,000 number of doctors who accept Medi-Cal will decline.
“It would be really helpful for policymakers to have an agreed upon set of facts,” Andrew Bindman, director of the University of California-based California Medicaid Research Institute, told Bazar.
Staff writer Rachel Cook of The Bakersfield Californian contributed to Emily Bazar's report.