Editorials

EDITORIAL: Obamacare is working, but problems must be solved

With the first open enrollment deadline for Obamacare approaching, the good news is that the Affordable Care Act is making a difference here.

At last count, only 11% of Californians were living without health insurance, down from 17% last year at this time. Doctors and local emergency rooms are seeing a dramatic drop in uninsured patients. Sick people can no longer be denied coverage because of a pre-existing condition. Parents can keep their grown children on their insurance. Enrollment is easier.

Signups for new coverage, through expanded Medi-Cal or via the state exchange, Covered California, have been higher than in any state in the nation. Technical kinks have been worked out.

Monday is the deadline for those on Covered California to change their health plans if they want their fix to take effect by January 2015. But that crunch hasn’t stopped new signups from proceeding at twice the pace of last year.

The bad news is that Obamacare could become a victim of its own success here if we don’t find some way to ensure that there will be enough medical care to go around.

Complaints already are mounting from enrollees whose doctors won’t take Medi-Cal or Covered California insurance. One saga, from Catherine Keefe, an Orange County poet, went viral after the Washington Post printed it on their op-ed page.

“In each case, the doctor’s office said the reimbursements for the insurance we had were too low,” she wrote, detailing her husband’s quest for a urologist willing to take Covered California. “In each case, the receptionists chirped, ‘We’re happy to make you a cash patient.’ ”

And she isn’t even a Medi-Cal patient. For them, non-emergency waiting times for a doctor can now exceed three months, according to the CHCF Center for Health Reporting.

This is not just a California problem. A study by the inspector general of the U.S. Department of Health and Human Services found that half of the doctors who are listed nationally as serving Medicaid patients were unavailable to treat them.

But California’s version of Medicaid does reimburse physicians at one of the lowest rates in the nation, and fully one-third of California’s population is on Medi-Cal now, with the expansion. With Gov. Jerry Brown considering expanding Medi-Cal coverage further to include residents shielded from deportation under the new immigration policy of President Barack Obama, the health care bottlenecks could become epic.

That’s why we need solutions now. Some are in the pipeline. Next month, for example, a new law will allow medical students to become licensed physicians in three years instead of four.

But much more is needed. Nurse practitioners, pharmacists, nurse midwives and other “non-doctor” doctors can and should be empowered to take on more responsibility for patient treatment. Legislators and state officials need to make it easier for returning vets with experience as, say, medics to be fast-tracked through health care degree programs.

And yes, reimbursement rates should be looked at, as physicians’ lobbyists annually remind the public. But not unless we also look at other incentives, such as expanded student loan forgiveness for doctors who commit to fields where the need is acute, such as primary care, gerontology and rural health care.

The Legislature should look at these and more as health care reform gets its bearings. Let’s not let the bad news outweigh the good in health care reform.

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