Holes remain in health care law

By Nick Tabor, New Era Senior Staff Writer

The Affordable Care Act aims, above all, to solve the problem that millions of Americans can’t get access to medical treatment.

Since the U.S. Supreme Court didn’t strike down the law Thursday, there could be an influx of previously uninsured people who have health coverage by the end of 2014.

But insurance alone won’t guarantee everyone access to doctors. Now the biggest challenge for Christian County — and for Kentucky — will be finding enough medical providers to serve everyone, some health officials say.

“The real issue that needs to be addressed right now is, how do we train more physicians and other health care providers?” said Dr. David Dunn, a health policy expert and transplant surgeon at the University of Louisville, in a phone interview Thursday.

Within four years, Kentucky will be short 3,000 to 4,000 doctors, Dunn said.

The New Era reported last month that Christian County has, at most, one primary care doctor for every 2,000 people. But Teresa Bowers, Jennie Stuart Medical Center’s physician recruitment director, estimated the ratio was closer to one to 4,000.

Further, a survey released last year showed roughly 32 percent of Western Kentucky’s adult residents under 65 don’t have health insurance. In Christian County, this would equate to more than 22,000 people.

When all these people can pay for treatment via insurance, doctors’ waiting lists may double or triple.

Dr. Keith Toms, who works at Generations Primary Care with his wife, Dr. Elizabeth Toms, believes the Affordable Care Act will benefit everyone — which puts him in a minority of doctors, he said. But he anticipates demand for doctors to shoot up.

“In the setting of a primary care shortage in our area, patients will now be able to afford insurance coverage but have no physicians to see them,” Toms wrote in an email. He added that many people who will get insurance have neglected their health for a long time — because they had no choice.

Patients who already have a physician will likely see no change in their access to treatment, Toms said.

Eric Lee, president and CEO of Jennie Stuart Medical Center, said he doubts the law will affect the hospital’s daily operations in a significant way. And some of the changes it provoked — such as core measures, which rate hospitals’ performances in four categories, and value-based purchasing — would have continued improving hospitals’ operations regardless of the Supreme Court’s decision.

Lee believes Jennie Stuart is “much better prepared than a lot of community hospitals” for the new law. Since September, four primary care doctors affiliated with Jennie Stuart have started practicing in this area. Another four will join the workforce by the summer’s end, Lee said.

E. Baron Whitaker, president and CEO of Trover Health System, estimated that as many as one in four Kentuckians who get insurance under the new law will be on Medicaid. Often, Medicaid status creates an extra barrier to finding a doctor.

Medicaid is a joint insurance program between the federal and state governments, available to those who can’t afford any other insurance. And since Kentucky has one of the lowest per-capita income levels in the U.S., the vast majority of uninsured Kentuckians will get Medicaid, Whitaker said.

Medicaid only reimburses hospitals an average of 85 percent of actual treatment costs, and the reimbursement rate continues to decline, Whitaker said. He estimated Kentucky hospitals will lose a total of $1 billion in revenue from the Medicaid cuts.

The reimbursement rates are similarly low for private-practice doctors, so most doctors limit the number of Medicaid patients they’ll treat regularly. It’s necessary to keep their practices afloat.

Kentucky’s three medical schools — at University of Kentucky, University of Louisville and University of Pikeville — are enrolling more students to increase the state’s doctor supply.

Even so, the schools need more federal and state funding to keep expanding their class sizes, Dunn said.

“It’s absolutely mission-critical to solving the physician workforce shortage issues,” Dunn said.

Even if the schools get enough funding, it will take five or six years for the doctor supply to flourish, Dunn said.

At Pennyroyal Mental Health, roughly 55 percent of the patients are in deep poverty, and about half of those are uninsured, said David Ptaszek, the organization’s director.

Ptaszek said getting these people insurance is at least a starting point.

“Overall, I think I go back to a quote from my youngest son, who said, ‘Dad, when there’s 32 million Americans that don’t have some kind of health insurance, there’s something wrong,’” Ptaszek said.

He said he hopes the current system will expand so it can accommodate everyone in the U.S.

“I know that’s a huge goal,” he said. “But I certainly hope we can continue to approximate that.”