State variation in primary care physician supply: implications for health reform Medicaid expansions. 2011

Peter J Cunningham

Under the Patient Protection and Affordable Care Act (PPACA), Medicaid enrollment is expected to grow by 16 million people by 2019, an increase of more than 25 percent. Given the unwillingness of many primary care physicians (PCPs) to treat new Medicaid patients, policy makers and others are concerned about adequate primary care capacity to meet the increased demand. States with the smallest number of PCPs per capita overall--gen­erally in the South and Mountain West--potentially will see the largest per­centage increases in Medicaid enrollment, according to a new national study by the Center for Studying Health System Change (HSC). In contrast, states with the largest number of PCPs per capita--primarily in the Northeast--will see more modest increases in Medicaid enrollment. Moreover, geograph­ic differences in PCP acceptance of new Medicaid patients reflect differences in overall PCP supply, not geographic differences in PCPs' willingness to treat Medicaid patients. The law also increases Medicaid reimbursement rates for certain services provided by primary care physicians to 100 percent of Medicare rates in 2013 and 2014. However, the reimbursement increases are likely to have the greatest impact in states that already have a large number of PCPs accepting Medicaid patients. In fact, the percent increase of PCPs accepting Medicaid patients in these states is likely to exceed the percent increase of new Medicaid enrollees. The reimbursement increases will have much less impact in states with a relatively small number of PCPs accepting Medicaid patients now because many of these states already reimburse primary care at rates close to or exceeding 100 percent of Medicare. As a result, growth in Medicaid enrollment in these states will greatly outpace growth in the num­ber of primary care physicians willing to treat new Medicaid patients.

UI MeSH Term Description Entries
D007348 Insurance, Health Insurance providing coverage of medical, surgical, or hospital care in general or for which there is no specific heading. Group Health Insurance,Health Insurance,Health Insurance, Voluntary,Health Insurance, Group,Health Insurances,Insurance, Group Health,Insurance, Voluntary Health,Insurances, Health,Voluntary Health Insurance
D007349 Insurance, Health, Reimbursement Payment by a third-party payer in a sum equal to the amount expended by a health care provider or facility for health services rendered to an insured or program beneficiary. (From Facts on File Dictionary of Health Care Management, 1988) Health Insurance Reimbursement,Reimbursement, Health Insurance,Third-Party Payments,Third-Party Payers,Health Insurance Reimbursements,Insurance Reimbursement, Health,Insurance Reimbursements, Health,Payer, Third-Party,Payers, Third-Party,Payment, Third-Party,Payments, Third-Party,Reimbursements, Health Insurance,Third Party Payers,Third Party Payments,Third-Party Payer,Third-Party Payment
D008484 Medicaid Federal program, created by Public Law 89-97, Title XIX, a 1965 amendment to the Social Security Act, administered by the states, that provides health care benefits to indigent and medically indigent persons. Dental Medicaid Program,Medical Assistance, Title 19,Dental Medicaid Programs,Medicaid Program, Dental,Medicaid Programs, Dental,Program, Dental Medicaid,Programs, Dental Medicaid
D010821 Physicians, Family Those physicians who have completed the education requirements specified by the American Academy of Family Physicians. Family Physician,Family Physicians,Physician, Family
D011320 Primary Health Care Care which provides integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community. (JAMA 1995;273(3):192) Primary Care,Primary Healthcare,Care, Primary,Care, Primary Health,Health Care, Primary,Healthcare, Primary
D006297 Health Services Accessibility The degree to which individuals are inhibited or facilitated in their ability to gain entry to and to receive care and services from the health care system. Factors influencing this ability include geographic, architectural, transportational, and financial considerations, among others. Access To Care, Health,Access to Care,Access to Contraception,Access to Health Care,Access to Health Services,Access to Medications,Access to Medicines,Access to Therapy,Access to Treatment,Accessibility of Health Services,Availability of Health Services,Contraception Access,Contraceptive Access,Medication Access,Accessibility, Health Services,Contraceptive Availability,Health Services Geographic Accessibility,Program Accessibility,Access to Cares,Access to Contraceptions,Access to Medication,Access to Medicine,Access to Therapies,Access to Treatments,Access, Contraception,Access, Contraceptive,Access, Medication,Accessibilities, Health Services,Accessibility, Program,Availability, Contraceptive,Care, Access to,Cares, Access to,Contraception, Access to,Contraceptive Accesses,Health Services Availability,Medication Accesses,Medication, Access to,Medicine, Access to,Medicines, Access to,Therapy, Access to,Treatment, Access to
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D014481 United States A country in NORTH AMERICA between CANADA and MEXICO.
D016312 Treatment Refusal Patient or client refusal of or resistance to medical, psychological, or psychiatric treatment. (APA, Thesaurus of Psychological Index Terms, 8th ed.) Avoidance of Health Care,Avoidance of Healthcare,Avoided Health Care,Avoided Healthcare,Health Care Avoidance,Healthcare Avoidance,Patient Refusal of Treatment,Refusal of Treatment,Anesthesia Refusal,Patient Elopement,Anesthesia Refusals,Elopement, Patient,Refusal, Anesthesia,Refusals, Anesthesia,Treatment Refusals
D058991 Patient Protection and Affordable Care Act An Act prohibiting a health plan from establishing lifetime limits or annual limits on the dollar value of benefits for any participant or beneficiary after January 1, 2014. It permits a restricted annual limit for plan years beginning prior to January 1, 2014. It provides that a health plan shall not be prevented from placing annual or lifetime per-beneficiary limits on covered benefits. The Act sets up a competitive health insurance market. Affordable Care Act,Affordable Care Act (ACA),Health Care Reform Act,Obamacare,PL 111-148,PL111-148,Public Law 111-148,111-148, PL,Act, Affordable Care,Acts, Affordable Care,Acts, Affordable Care (ACA),Affordable Care Acts,Care Act, Affordable,Care Act, Affordable (ACA),Care Acts, Affordable,PL 111 148,PL111 148,Public Law 111 148

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