Access to Medical Care Will Decrease, Not Increase, Under the Affordable Care Act

With President Obama’s signature policy achievement set to take full effect in 2014, we are already seeing troubling signs that the Affordable Care Act (ACA) will not only fail to live up to its promises, but will make some of our current health care problems much worse and end up hurting the people it was designed to help. The central promise of the ACA is that it will increase access to care for millions of Americans. However, because the ACA will also worsen an already chronic shortage of physicians, it is likely to make it harder, not easier, for Americans to obtain quality medical care.

In 2012, the Association of American Medical Colleges (AAMC) estimated that the overall US physician workforce will increase by only 7% in the next 10 years, with some specialties such as urology and thoracic surgery actually seeing a decline in supply. During the same time frame, the US Census Bureau predicts that the number of Americans older than age 65 will increase by more than 35%. This is the precise patient population that needs these specialties’ services the most.

With many Americans, even those with insurance, facing decreased access to medical care provided by physicians, the last thing we need is health care “reform” that makes the situation worse. Yet that’s exactly what the ACA will do, despite the promises that it will provide expanded access to care for millions of Americans.

The AAMC warns that the ACA, in an effort to insure an additional 32 million Americans, “will increase the need for doctors and exacerbate a physician shortage driven by the rapid expansion of the number of Americans over age 65.” As a result, the AAMC’s Center for Workforce Studies predicts that “by 2020 our nation will face a serious shortage of both primary care and specialist physicians — we’ll need an extra 45,000 primary care physicians and 46,000 surgeons and medical specialists to provide care for all of the newly insured and our rapidly aging population. With an increased patient population and fewer primary care physicians to evaluate and refer, there will be delays in treatment that result in poorer outcomes.

Many observers predicted that the ACA would have this effect, but now we are seeing it in action. According to the Los Angeles Times, as California moves to “expand healthcare coverage to millions of Californians under President Obama’s healthcare law, it faces a major obstacle: There aren't enough doctors to treat a crush of newly insured patients.”

California lawmakers are responding to the projected shortfall by drafting legislation that “will allow physician assistants to treat more patients and nurse practitioners to set up independent practices. Pharmacists and optometrists could act as primary care providers, diagnosing and managing some chronic illnesses, such as diabetes and high-blood pressure.”

This move could jeopardize patient safety and also drive up costs, because non-physicians have less medical education and training, “and tend to order more tests and prescribe more antibiotics.” It would also only exacerbate the physician shortage by creating a concomitant shortage of these clinicians in the clinics, hospitals, and offices where they now work.

It’s not only California that’s facing these hard truths; physicians all over the country are feeling the pinch from the ACA, with many deciding to leave practice altogether. American Medical News recently reported on the danger of a “silent exodus” of physicians who are “frustrated by mounting regulation, declining pay, loss of autonomy and uncertainty about the effect of health system reform.” Faced with this burden, more and more doctors are cutting back on hours and reducing the number of patients they see. According to Mark Smith, president of doctor-recruiting firm Merritt Hawkins & Associates, “Physicians are feeling extremely overtaxed, overrun, and overburdened.”

This trend will likely accelerate as physicians are exposed to the full effects of the ACA over time. According to this article, “The medical rumor mill is abuzz with stories about physicians girding for Obama’s signature domestic policy achievement by limiting their exposure to Medicare and Medicaid, selling their practices, converting to fee-for-service approaches, or even retiring from medicine altogether.”

Saddling chronically overworked physicians with burdensome new rules and regulations, reducing their pay, and then requiring them to increase their patient load is a recipe for disaster. It’s only natural that many of them will reduce their hours, refuse to take Medicaid, or take other steps to regain control of their practice and livelihood. Unfortunately, this likely will translate into less, not more, access to care for many patients.