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What Surge? Nation’s Primary Care System Holding Up Well So Far Under Obamacare


Millions Still Waiting For Medicaid Cards

Several factors are thought to have muted early demand, from the late surge in enrollees — a million people signed up just since March 31 so their policies are just taking effect now—to an unusually cold and snowy winter in the Northeast and Midwest.

But the most significant is that more than 5 million people projected to gain coverage remain uninsured because only half the states expanded Medicaid.

And while Medicaid saw a net growth of 4.8 million people since October, more than a million who signed up are waiting to get the cards that are their admission tickets to free or low-cost doctors’ visits. In California alone, 900,000 people are waiting for their cards because of backlogs.

That may account for why several health centers in California said they had seen no significant increase in new patients, although the state enrolled more than 3 million people in private plans and Medicaid.

Although more people have sought care—as seen in the nearly 10 percent jump in health spending described in an April government report—Glied said there are enough providers in most places to care for them.

“The primary care system is not being stretched to its absolute limits,” she said.

She estimated that about 4 percent of the U.S. population gained insurance this year but many of them are young and “relatively low users of health care.”

Many of the concerns about people experiencing delays grew out the experience in Massachusetts after that state adopted near-universal coverage in 2006. Wait times for a doctor’s appointment rose to an average of 50 days with some as long as 100 days, according to a Massachusetts Medical Society report in 2008.

But Glied notes that Massachusetts’ residents historically had long waits for primary care visits so their experience is not a good indicator.

And unlike the Massachusetts law, the Affordable Care Act gave health providers more than three years to prepare. In that time, the federal government has spent billions expanding community health centers while private practices have added nurse practitioners and physician assistants and adopted electronic health records.

“Despite the widely publicized shortage of primary care physicians, primary care capacity does exist in each state,” said Karin Rhodes, director of the Center for Emergency Care Policy & Research at the University of Pennsylvania School of Medicine.

Rhodes was the lead author of a study published last month in JAMA Internal Medicine in which researchers posing as new patients called about 8,000 primary care practices in 10 states. The vast majority quickly secured appointments although those with Medicaid had a tougher time.

Physicians scheduled visits for 85 percent of callers posing as patients with private insurance, and for 58 percent of those posing as patients with Medicaid. Median wait times were just under one week.

Mon, May 12 2014

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