Obamacare could hurt efforts to boost rural care in Oklahoma

The Oklahoman Editorial Published: June 8, 2012

WITH each passing day, it becomes increasingly clear that the federal government's effort to jam a square peg through a round hole (Obamacare through our health care system) won't end well for patients. The problem is highlighted by local efforts to address the shortage of doctors in rural Oklahoma.

State lawmakers this session provided about $3 million to create residency programs at hospitals in rural, underserved areas across the state. Officials want more doctors to do residencies in rural hospitals, hoping the experience will lead them to ultimately remain in those high-need locations. Medical schools also are trying to recruit students from rural communities, assuming those men and women are more likely to return home once they become doctors.

Oklahoma has long had a shortage of primary care physicians, particularly in rural areas, due to numerous factors. But the problem will only get worse once Obamacare takes effect and drives more people onto the Medicaid rolls, according to a 2011 report in the New England Journal of Medicine. The report found that Oklahoma has the greatest access challenges of all 50 states.

This state, the report says, is among eight that are “expected to have large Medicaid expansions, yet now have weak primary care capacity. In the absence of additional efforts, the demand for care by newly insured patients could outstrip the supply of primary care providers in these states.”

The report warns that if “new demand exceeds the supply of care, the result could be increased waiting times and access barriers” not only for Medicaid patients, but all citizens.

In addition to increasing the strain on the limited supply of doctors, Obamacare's reliance on dumping citizens on the Medicaid rolls may create price pressures that leave other families unable to afford private insurance. A 2008 report by the Milliman consulting firm noted government programs such as Medicaid pay providers “significantly” lower rates than do commercial health plans and haven't kept up with costs. As a result, the Milliman report notes government programs shift costs to private insurance “essentially through a hidden tax.” The report estimated that insurance premiums for a family of four cost an additional $1,512 annually due to the cost shift from Medicare and Medicaid.

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