MICHIGAN — A new report suggests that some of the fears about expanding Medicaid in Michigan seem to be misguided.
Survey results from an Ann Arbor health care research group dispel the notion that if Michigan expands Medicaid, then the tens of thousands of people receiving coverage would have trouble getting in to see a doctor because of the influx of patients.
How that may play into any decision on the expansion question is unknown as Gov. Rick Snyder prepares to offer a recommendation to legislators this week when he presents his budget proposal for the state’s 2013-14 fiscal year.
“At this point, the governor and his team are closely analyzing the impacts and ramifications of any decision. They are working hard to study and evaluate the options that will help determine the best course of action that provides protection and security for Michiganders,” Kurt Weiss, a spokesperson for the governor, stated in an email to MiBiz. “It’s not a decision the governor feels can be made immediately or lightly.”
Weiss declined to comment specifically on the survey data from the Center for Healthcare Research & Transformation “because there are many studies and many sources of data the governor is looking at.” Capacity is just one of many criteria Gov. Snyder is weighing in his decision, Weiss said.
“He won’t be basing his decision on findings from one group or study. The governor wants to be sure that if we do a Medicaid expansion, that sufficient capacity exists in the physician and insurance market to support the large influx of individuals. He wants this to result in individuals getting a primary care physician who is the primary point person for care, which helps with preventive care and a healthier population with better health outcomes,” Weiss stated. “In short, the governor wants to make sure we’re actually improving health outcomes and not just paying for more emergency room visits.”
The Center for Healthcare Research & Transformation survey results indicate that most doctors in Michigan have the ability to take more patients into their practices and that they would accept new Medicaid patients. The data counters a key question about expanding Medicaid: whether a physician shortage leaves the system unable to handle the thousands of people in Michigan who would gain coverage and have a better financial ability to access care.
“Our data is telling us that we will indeed have enough physicians to take care of patients if we do expand Medicaid,” said Marianne Udow-Phillips, director of the Center for Healthcare Research & Transformation.
The same goes for people who would get better access coverage from private health plans when provisions of the federal Affordable Care Act kick in Jan. 1 of next year.
The results challenge not only a wide-held notion about Medicaid expansion but also the center’s own assumption as well.
“All of this surprised us,” Udow-Phillips said. “We did not expect that we would see such a high rate of physicians saying that they were really able to expand their practices, and particularly that they were ready to take more Medicaid patients. This part of the survey was quite surprising, I have to say.
“It definitely was not what we expected. We expected much lower numbers.”
In the random survey late last year of 1,500 physicians, conducted with the Child Health Evaluation and Research Unit at the University of Michigan, 81 percent of primary-care doctors said they expect to expand their practice to accept newly insured patients in 2014. Ninety percent of those doctors also indicated they would accept new Medicaid patients, according to survey results.
Even among doctors who currently do not accept new Medicaid patients, nearly nine of 10 said they would accept those patients if the state expands the program.
In West Michigan, a lower percentage of physicians — 71 percent in Kalamazoo County, 61 percent in Ottawa County and 56 percent in Kent County — said they expect to have capacity for new Medicaid patients.
The survey results can help to settle doubts about whether the health care system can handle the influx of patients expected under the Affordable Care Act, Udow-Phillips said.
“We hope it answers the fundamental question,” she said.
An earlier paper issued in October by the Center for Healthcare Research & Transformation concluded that expanding Medicaid under the Affordable Care Act makes economic sense for the state. It would save an estimated $840 million to $1.4 billion over a decade as more than 600,000 people gain access to health coverage by 2020.
Under the health reform law, the federal government would cover 100 percent of the expansion cost for the first three years and 90 percent beginning in 2017.
When the Affordable Care Act initially passed, it required states to expand Medicaid eligibility. The decision last June by the U.S. Supreme Court upheld the federal health care law but struck down provisions that would penalize states if they fail to expand eligibility.
That left states the option of expanding Medicaid, a prospect that has strong political opposition among Republicans who oppose the Affordable Care Act as a whole.
While the non-partisan Center for Healthcare Research & Transformation does not advocate or lobby for policy positions, Udow-Phillips believes the October study and the new survey data combined “does sort of lead to a conclusion that’s hard to avoid.”
“With those two pieces of data, we think policymakers — if they are making decisions based on data — ought to be saying, ‘We should expand Medicaid in Michigan,’” she said. “The data should speak for itself.”
Enabling physicians to absorb the new patient volume is a decline in business resulting from the economic downturn. That combines with increased efficiency through changes in practices that allow for higher patient caseloads, including the adoption of the patient-centered medical home model, deployment of electronic health records and the greater use of physician assistants and nurse practitioners.
“Those changes are enabling them to take more patients,” Udow-Phillips said.