Editorials

Don’t let good news go bad on health reform

Fans of Covered California show their support during a promotional stop in San Jose. California’s health care exchange is one of Obamacare’s good news stories, but a potential doctor shortage is creating concern.
Fans of Covered California show their support during a promotional stop in San Jose. California’s health care exchange is one of Obamacare’s good news stories, but a potential doctor shortage is creating concern. The Associated Press

With the season’s first Obamacare deadline approaching, the good news is that the Affordable Care Act has made a difference here.

Only 11 percent of Californians are without health insurance, down from 17 percent last year. The Bee’s Phillip Reese reported that local emergency rooms are seeing a dramatic drop in uninsured patients. The sick can no longer be denied coverage because of pre-existing conditions. Parents can keep grown children on their insurance. Enrollment is easier.

Sign-ups 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 health plans if they want their fix to take effect by January. But that crunch hasn’t stopped new sign-ups 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. One lament, from Catherine Keefe, a writing instructor at Chapman University in Orange County, went viral after The Washington Post printed it.

“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 on Medi-Cal. There, nonemergency waits for a doctor can now exceed three months, according to the California Healthcare Foundation’s Center for Health Reporting.

This is not just a California problem. The U.S. Department of Health and Human Services recently found that half of the doctors 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 still further to include residents shielded from deportation under the new immigration policy of President Barack Obama, the bottlenecks could become epic.

We need solutions now, and 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.

More is needed. Nurse practitioners and other “non-doctor” caregivers should be empowered to take on more patient treatment. California needs to make it easier for returning vets with experience as, say, medics to be fast-tracked through health care degree programs.

And yes, reimbursement should be reviewed, as doctors’ lobbyists keep reminding. But not unless we also look at other incentives, such as expanded student loan forgiveness for doctors in fields where the need is acute, such as primary care and rural health care.

Lawmakers should think about these. Let’s keep the good news coming in health care reform.

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