In Texas, Uneven Expansion Of Obamacare Sows Frustration

Feb 29, 2016
Originally published on March 11, 2016 2:58 pm

People in Texas are significantly more likely than adults nationwide to report that it has gotten harder to see a doctor in the past two years.

The finding comes from polling done by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health.

Vera Brown has been stuck aboard the doctor merry-go-round for years now, trying to find an orthopedic surgeon who accepts her insurance. She doesn't find the seemingly endless calls, questions or repetition amusing.

"When they say I'm not covered that means I have to put off having surgery," she says. "And that begins to start messing with my health."

Brown, 45, has already had one hip replaced. Now, the other is starting to feel numb. She used to be in physical therapy, but the clinic stopped accepting her insurance, which is provided by Medicaid.

She gets around her South Dallas apartment with the help of a walker. With an 11-year-old son still at home and a fixed income, she says traveling is hard.

"If you have a little money and you can go to wherever doctor, that's fine, but what about the ones that does not have the income, or the say-so or the know-how, to go about doing this?" Brown asks. "We just lost out. And that's just not right."

Almost 1 in 5 people in Texas says it's gotten harder to see a doctor in the past two years according to the NPR poll. It didn't matter what kind of insurance they had.

About 70 percent of insurance plans for Texans available on HealthCare.gov are small ones, according to Dan Polsky, a health economist at the University of Pennsylvania.

Insurers tend to offer patients with narrow networks that include fewer choices of doctors and hospitals.

Insurers are "using this as a cost-control measure," says John Carlo, CEO of the nonprofit AIDS Arms health agency in Dallas. "So it's very likely that someone who in the past has had a lot more access to specialists they're not finding that anymore and they're having to travel greater distances to find those specialists."

Staying on top of which doctors are in or out of network is hard for health care administrators and patients. Carlo says his health agency has had to refer patients elsewhere who've been coming for years.

"Frankly, it's a mess," Carlo says. "We just see this so frequently where a patient comes in, they're carrying a health plan card, it looks good, they double-check and when they go to file the claim to be reimbursed they find out they're not in the network."

And if you do find a doctor in network, there's the problem of actually scheduling an appointment. About a quarter of adults in Texas who do have a regular doctor say there's been at least one time in the past two year when they needed care but couldn't see their regular provider.

Most say it was because the doctor didn't have available times. Texas Health Institute researcher Dennis Andrulis says the Affordable Care Act has helped more than a million Texans get insurance, but the state has a severe physician shortage. In Texas, there are about 186 physicians for every 100,000 people, according to the Texas Medical Association. The national average is 236 per 100,000.

"The law is raising hopes for those who in this state have been chronically uninsured for such a long time," Andrulis says. "But then for those who are able to get insurance, they will find difficulty in accessing care."

The situation is particularly frustrating for people on Medicaid, says Andrulis, who is also associate professor at the University of Texas School of Public Health in Austin. First, Texas chose not to expand Medicaid under the Affordable Care Act. Second, the rates the state reimburses doctors for care are very low. As a result, doctors in Texas have little incentive to take on new Medicaid patients.

Add it all up, and you see that Texas is a state with 6 million uninsured people, few primary care doctors, narrow provider networks and low reimbursement rates for Medicaid.

"These are the seeds and reality of frustration," Andrulis says.

No wonder then, says Andrulis, that so many Texans who can't see a doctor in a timely manner go to the emergency room instead.

As for Vera Brown, she uses a community health clinic where costs are low. Her mother helps out with medicines she's got.

"She will give you a hug like no other," Brown says. "It will sooth your soul, and when you get through it's like everything just gone away."

And for a minute, she can ignore the pins and needles in her hip, and pick up the phone to make a few more calls to find a doctor.

Copyright 2017 KERA. To see more, visit KERA.

AUDIE CORNISH, HOST:

Compared to adults nationwide, people in Texas are much more likely to say it's gotten harder to see a doctor over the past two years. That's one finding in a new poll from NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health. From KERA, Lauren Silverman takes a closer look at the barriers to health care in Texas.

VERA BROWN: My name is Vera Brown, and I'm trying to find a orthopedic surgeon that will take Superior.

LAUREN SILVERMAN, BYLINE: Vera Brown has been stuck aboard the doctor merry-go-round for years now.

UNIDENTIFIED MAN: Thanks for calling (unintelligible) health care.

SILVERMAN: She doesn't find the endless calls, questions or repetition amusing.

BROWN: When they say that I'm not covered, that means that I have to put off having surgery, and that begins to start messing with my health.

SILVERMAN: Brown, who's 45, has already had one hip replaced. Now the other is starting to feel numb. She used to be in physical therapy, but the clinic stopped accepting her insurance which is provided by Medicaid. She gets around her South Dallas apartment with the help of a walker. With an 11-year-old son still at home and a fixed income, traveling is hard.

BROWN: But if you have a little money and you can go to whatever doctor, that's fine, but what about the ones that does not have the income or the say-so or the know-how to go about doing this? We just lost out, and that's just not right.

SILVERMAN: Almost 1 in 5 people in Texas says it's gotten harder to see a doctor in the past two years according to the NPR poll. It didn't matter what kind of insurance they had. Dr. John Carlo says across the board, health insurance plans have narrowed their networks, shrinking the number of doctors and hospitals patients can see.

JOHN CARLO: The health plans are contracting with fewer and fewer health providers and hospitals, and they're using this as a cost-control measure. So it is very likely that somebody that in the past has had a lot more access to specialists - they're not finding that anymore, and they're having to travel greater distances to find those specialists.

SILVERMAN: About 70 percent of plans available on healthcare.gov in Texas are size small according to Dan Polsky of the University of Pennsylvania. Staying on top of which doctors are in or out of network is hard for administrators as well as patients. Carlo says his nonprofit health agency, AIDS Arms, has had to refer out patients who've been coming for years.

CARLO: Frankly, it's a mess. We just see this just so frequently where a patient comes in. You know, they're carrying a health-plan card. It looks good. They double check, and then when they go to file the claim to be reimbursed, they find out that they're not in the network.

SILVERMAN: And if you do find a doctor in network, there's the problem of actually scheduling the appointment. About a quarter of adults in Texas who do have a regular doctor say there's been at least one time in the past two year when they needed care but couldn't see their regular provider. Texas Health Institute researcher Dennis Andrulis says the Affordable Care Act has helped more than a million Texans get insurance, but the state has a severe physician shortage.

DENNIS ANDRULIS: What happens is the law is raising hopes for those who, in this state, have been chronically uninsured for such a long time. But then for those who are able to get insurance, they will find difficulty in accessing care.

SILVERMAN: Andrulis says for people on Medicaid, the situation is particularly frustrating. Texas chose not to expand Medicaid, and the rate it reimburses doctors for care is very low. The result - physicians in Texas have little incentive to take on new patients.

ANDRULIS: These are the seeds and the realities of frustration.

SILVERMAN: It doesn't surprise Andrulis that the majority of Texans who can't see a doctor in a timely manner go to the emergency room instead. As for Vera Brown, she uses a community health clinic where costs are low, supplemented by some medicine by her mother.

BROWN: She will give you a hug like no other. It will sooth your soul. And when you get through, it's like everything just gone away.

SILVERMAN: And for a minute, she can ignore the pins and needles in her hip and pick up the phone to make a few more calls to find a doctor. For NPR News, I'm Lauren Silverman in Dallas. Transcript provided by NPR, Copyright NPR.