Even With Medicaid Coverage, Some Poor Americans Still Can’t Get The Health Care They Need

California’s state Medicaid program, Medi-Cal, has struggled to remain fully funded as its budget — and particularly the reimbursements that go toward the doctors who accept poorer patients under the program — perennially falls under the knife. And the low-income Americans who need specialist care are particularly susceptible to the shortcomings of the strained social safety net.

The Los Angeles Times reports that poor Americans seeking access to specialist services — such as complex surgeries and neurological treatment — are faced with a dearth of specialists willing to service Medi-Cal, mostly due to its historically low reimbursement rates. And on top of that, the United States continues to face a growing doctor shortage that is leading to long waiting periods for Americans:

By the end of the decade, the nation will be short more than 46,000 surgeons and specialists, a nearly tenfold increase from 2010, according to the Assn. of American Medical Colleges. Healthcare reform is expected to worsen the problem as more patients — many with complex and deferred health needs — become insured and seek specialized treatment.

Many of the newly insured will receive Medi-Cal, the government plan for the needy as administered through the state of California. Clinics already struggle to get private specialists to see Medicaid patients because of the low payments to doctors. Last week, an appellate court decision that authorized the state to move forward with 10% cuts in Medi-Cal reimbursement, which could make finding doctors for those patients even more difficult.

“Specialists are paid so poorly that they don’t want to take Medi-Cal patients,” said Mark Dressner, a Long Beach clinic doctor and president-elect of the California Academy of Family Physicians. “We’re really disappointed and concerned what it’s going to do for patient access.”

This shortage disproportionately affects Americans on Medicaid because the program’s lackluster funding makes it difficult to attract specialists who — after expensive and time-consuming stints in medical school — are willing to take on poor patients for lower reimbursements. Unfortunately, saddled with long waiting periods for specialist treatment, some Americans resort to inefficient and expensive emergency room care, raising health care spending nationally.

Obamacare seeks to quell this problem by vastly expanding funding for states that open up their Medicaid pools to more Americans and providing medical schools incentives for producing more general practitioners and family doctors. But as the LA Times notes, the medical school incentives do not also extend to specialists, and all the extra Medicaid funding in the world will mean little if states do not offer doctors reimbursements high enough to attract their services.

Since the downward trend in Americans becoming doctors has long been in the pipeline, the health reform law is not the root cause of this shortage. But since Obamacare expands the Medicaid program to extend coverage to millions of previously uninsured Americans, it does highlight just how deep the existing shortage is.