Access to Care Report/This Week (#3)/More Patients Coming: How Will Access to Medical Care Be Affected? And Legal Practices?

July 25, 2013

health-care-lawThe creation of marketplace Exchanges under the Affordable Care Act (to sell subsidized private health insurance) and associated implementation of the expanded Medicaid program (in some states) are both likely to increase the numbers of patients seeking medical care.

Other factors at work—that will also increase the numbers of patients—are the aging of the population and more services being provided by the Health Care System (more service intensity).

How will legal practices be affected by more patients seeking medical care?

More individuals with insurance coverage will usually translate into more patients for providers, as financial barriers are lowered. For the ACA, these barriers are being reduced by positive features (income subsidies through Exchanges for those with midlevel incomes, and “free” Medicaid care for those with low incomes who have not previously been eligible).

However, there are going to be some barriers associated with these programs: cost sharing for services paid for under the new policies from Exchanges may range from 10% to 40% of average medical costs (actuarily determined) and Medicaid limitations on payments can reduce the numbers of available providers.

It is reasonable to estimate that significant increases in numbers of patients will result from the ACA and other factors. An important question with implications for legal practices is “How much will patient numbers increase over the next few years?”

The issue of access to primary care up to 2025 has been addressed in a recent Report by Paul Howard and Yevgeniy Feyman of the Manhattan Institute. In something of a surprise, based on their modeling, they have concluded that the impact of the ACA on patient demand will be “relatively minor”.

They state that “population growth and demographic (aging) changes will require some 44,000 more primary care physicians by 2025. The insurance expansion…(under the ACA)…will necessitate about 8,800 more physicians to meet increases in demand, all else held equal”.

Thus, the impact of the ACA on primary care is seen as just one factor contributing to demand. Co-author of this Report Paul Howard has also emphasized this point in a follow-up column “Get Obamacare, while supplies last.”

How will the Health Care System likely respond to this situation? Reactions may involve expanded licensing for nurse practitioners and physician assistants to help fill the gap; increased productivity for all providers; better triage; more community-based care; and longer queues and possible rationing to reduce patient flow.

How will this impact legal practices? Attorneys supporting individual clients may be required to help deal with queues, restricted access, and triage effects. Many clients may need help dealing with out-of-pocket expenses and lack of access due to low amounts paid to providers by Medicaid. Legal assistance may be required to help clients look for alternative care options.

Attorney support for individuals will not come to an end with helping establish eligibility for private insurance or Medicaid. Follow-up access to care will be driven by a variety of other factors.

In turn, attorney support to providers may involve dealing with the legal aspects of efforts to: improve productivity; implement licensure changes; develop legal relationships for alternative community-based care; and deal with unsatisfactory delays being experienced by individuals seeking care.

The legal problems of those with new coverage and those “aging” into higher levels of need will be similar. More patients are likely to need increased attorney assistance regarding all aspects of access to care.

This is #3 in a series of weekly Access to Care Reports.

#1 – Access to Care Report/This Week (#2): Electronic Medical Records Can Impair Legal Accountability and Access

#2 –  The Access to Care Report/This Week (#1): How Health Needs Are Measured Makes a Difference — In Legal Practice