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Medical office - middle-aged male doctor greeting patient, shaking hands.
Yep, this is still happening.
One of the remaining talking points Republicans are using (now that enrollments are huge and people are paying up) is that somehow someone undeserving will take health care away from people who already had it. They'll have to wait forever just to get an appointment with their doctor and, somehow, the care their doctor provides them will be substandard. Because, well, they don't have a reason. Just because.

But, so far, the nation's primary care system is doing fine.

[T]he nation's primary care system is handling the increased number of insured patients without major problems so far, according to interviews with community health centers, large physician practices and insurers nationwide.

Five months into the biggest expansion of health coverage in 50 years—with about 13 million people enrolled in private insurance and Medicaid under the Affordable Care Act—there are few reports of patients facing major delays getting care, say officials from more than two-dozen health centers and multigroup practices, as well as insurers and physician groups in nine big states.

Some exceptions have surfaced, particularly in parts of Colorado, Kentucky and Washington state, which had some of the biggest gains in coverage.

Mostly, there are extended wait times for people who've been enrolled in expanded Medicaid in those states. The fact that 5 million people didn't get Medicaid because of all the states which refused to expand it accounts for a good part of the lower-than-expected demand. But some of the predictions of long wait times were based on the Massachusetts experience, where wait times for doctors appointments "rose to an average of 50 days with some as long as 100 days, according to a Massachusetts Medical Society report in 2008." But these researchers note that Massachusetts already had very long wait times before the reform law, so it's not really predictive of the rest of the country.

The primary health care system had three years to gear up for Obamacare, and the law included billions for expanding community health centers, which are picking up much of the Medicaid demand. Private providers had time to staff up with nurse practitioners and physicians assistants.

Because of the huge surge in late enrollments, there could still be a big hiccup coming in primary care, but it will be just that. A hiccup. It won't be health care armageddon in which no one gets to see their doctor in time.

Originally posted to Joan McCarter on Mon May 12, 2014 at 09:25 AM PDT.

Also republished by Obamacare Saves Lives and Daily Kos.

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Comment Preferences

  •  Tip Jar (32+ / 0-)

    "The NSA’s capability at any time could be turned around on the American people, and no American would have any privacy left, such is the capability to monitor everything. [...] There would be no place to hide."--Frank Church

    by Joan McCarter on Mon May 12, 2014 at 09:25:51 AM PDT

  •  So??? That's not what Rush Limbaugh says... (0+ / 0-)

    and he is right 99.7% of the time, donchaknow!

    The more you learn, the less you know.

    by quiet in NC on Mon May 12, 2014 at 09:36:15 AM PDT

  •  Just anecdotal, (4+ / 0-)

    I was scheduled for a doctor three days after the day I signed up. It was a Medicare enrollment.

    I'm not serious. Seriously.

    by IB JOHN on Mon May 12, 2014 at 09:37:56 AM PDT

  •  This was one that I was actually worried about. (7+ / 0-)

    On the other hand, high demand for health care providers is an indication of the pent up need, finally being addressed,  that has long gone unchecked. Also, I'm telling everyone that wants a job that healthcare (not plastics,lol) is the future.  Working in the healthcare industry is a wonderful career that allows one to leave their world a little better off than the way they found it. Clearly not everyone can become a doctor, nurse, etc... but their are tons of opportunities in a wide range of areas and qualifications.

    •  There has always been a long wait for physicals (3+ / 0-)
      Recommended by:
      the oklahoma kid, QuelleC, ER Doc

      I generally have to schedule 6 months in advance, and always did.

      However, with an insurance or medicaid card, you should be able to get into an Urgent Care Clinic for something like strep throat or a flu shot with little wait at all -- not ideal, but not the same issue as an annual physical.

      •  You're right about the long wait for physicals (1+ / 0-)
        Recommended by:

        That's always been an issue and it's actually deterring me from using my insurance.  I have  been untreated for 5 years and it would be best to have an overall physical, but honestly my depression and high blood pressure just can't wait... My college age son just told me he's been having pain and infection from his sideways wisdom teeth. So I felt like a pretty bad mom on Mother's Day.  

        We got Obamacare without dental (dental wasn't bundled with any of the plans, even platinum) 4/01 but being uninsured so long I still worry about the cost.  I'm getting different answers on whether I can go to the network clinic in the neighborhood or the one 10 miles away since my car is unreliable. I wonder if others with "pent up demand" are also afraid or are used to doing without.

        In fact, if the republicans would reinstate my $203 a week unemployment I could get the car fixed, get healthy, and go apply for a job at the two health insurance companies in my city.  See what happens when the republicans hammer you from all sides?  

  •  We need added incentives and scholarships (4+ / 0-)
    Recommended by:
    dksbook, HugoDog, TrueBlueDem, ER Doc

    for qualified med school students to increase the number of doctors our schools produce and the primary care clinics that open.  Like right now.

    Your kids are more than a test score, and so are their teachers.

    by gtnoah on Mon May 12, 2014 at 10:43:42 AM PDT

    •  We also need a hell of a lot more (2+ / 0-)
      Recommended by:
      gtnoah, ER Doc

      nurses and nurse practitioners, as well as physician's assistants as  allowed by state law.

    •  That's not the bottleneck. (2+ / 0-)
      Recommended by:
      gtnoah, ER Doc

      The bottleneck is the number of residency slots. If twice as many people went to medical school (which means expanding the schools, not just more scholarships), half of them would be unable to find residency slots when they finished. That's not at all useful.

      There are people working on this, but it's not a simple matter.

      What is more doable in the short run is increasing the slots available to train nurse practitioners and physicians' assistants, who are fully capable of handling a lot of the routine primary care tasks.

      The other useful route -- which is built into the ACA -- is incentives for new docs who choose to enter primary care rather than higher-paid (and over-populated) specialties. But it will take 5-10 years for that to make a significant impact on the number of primary care docs.

      •  Agreed. Like most things... (1+ / 0-)
        Recommended by:
        ER Doc

        We should have started much earlier on this.  Americans have no foresight.

        Your kids are more than a test score, and so are their teachers.

        by gtnoah on Mon May 12, 2014 at 01:41:38 PM PDT

        [ Parent ]

      •  Sleep Deprivation Slots (0+ / 0-)

        Why are residents worked for such extremely long shifts that they're sleep deprived, if there's a shortage of slots and an oversupply of applicants? Is the sleep deprivation by design, hazing them into accepting all the other extremes of the healthcare biz?

        "When the going gets weird, the weird turn pro." - HST

        by DocGonzo on Wed May 14, 2014 at 07:28:47 PM PDT

        [ Parent ]

  •  FYI - since ACA went into full effect, (5+ / 0-)

    wait times at my oncologist's office have decreased from a high of 63 minutes (believe me, I started timing it last year) to the longest wait being 5 minutes past my appointment time since January.  There are now about 50% more staff, including another doc and two more nurses.  The office staff is thrilled - more staff, plus more standardization forced computerization of records and fewer errors in insurance claims, which has saved patients precious time and that fear, aggravation and blood pressure spikes errors caused us.  It seems to be a win all around, at least from my perch on the exam table.

  •  I am always amused that Republicans, (2+ / 0-)
    Recommended by:
    wilderness voice, ER Doc

    purported believers in the free market, somehow don't believe the free market will respond to an increased demand for health care.

    “The future depends entirely on what each of us does every day.” Gloria Steinem

    by ahumbleopinion on Mon May 12, 2014 at 11:21:12 AM PDT

  •  The business community has caught on (1+ / 0-)
    Recommended by:
    ER Doc

    Headline in "Business Insider" on the Yahoo Finance pages yesterday: "The GOP's Latest Anti-Obamacare Talking Point Went Down In Flames." (They're debunking the "but they're not paying their premiums!" nonsense.)

    This may be yet another wedge that separates the establishment business-oriented GOP from the Tea Party screechers. Business people are used to making decisions on facts and data, not mythology. May it be so.

  •  De-bunk all the myths you like (2+ / 0-)
    Recommended by:
    ChadmanFL, otto

    They'll just make more.

    "I feel a lot safer already."--Emil Sitka

    by DaddyO on Wed May 14, 2014 at 06:41:38 PM PDT

    •  Yes they will (0+ / 0-)

      But I am glad the REALLY obvious right-wing bullshit like "death panels" and "you won't be able to find a doctor" have essentially died out.  Soon they'll be grasping at straws, leaving only really outlandish crap as excuses for why they perceive the ACA to suck.

      •  Not to argue, but... (0+ / 0-) are obviously conserving your sanity by not looking in the right places.

        These lies will only die when the cretins who believe them die. The Echo Chamber is deeper than the Onandoga Cave, friend.

        "I feel a lot safer already."--Emil Sitka

        by DaddyO on Thu May 15, 2014 at 12:39:20 PM PDT

        [ Parent ]

  •  this screening thing ... (0+ / 0-)

    what do you think it's effect really will be?

    not being good at connecting dots, i defer to the general assembly for conclusions. (hand me my sunglasses, please.)

    TRAILHEAD of accountability for Bush-2 Crimes? -- Addington's Perpwalk.

    by greenbird on Wed May 14, 2014 at 06:42:20 PM PDT

  •  Yes, my mom has NO problem (0+ / 0-)

    She was able to get insurance (a 100% platinum plan) for the first time in about 7 years.  She has had something like 8 different doctor's visits so far - a lot of catching up with having skin cancer removed and stuff she's put off for years.  She's used about $5k worth of health care in just 5 months and has had zero problems finding a doctor.  

    The "doctor/nurse shortage" was always a crock of shit.  It's basic supply and demand.  More people having health insurance means more people actually go to the doctor (rather than wasting ER resources when it's too late), which means more people will go into the field to meet increased demand for more doctors and healthcare practitioners.  The very nature of capitalism itself shoots down the whole "there's going to be a shortage of doctors" BS.

  •  Lots of jobs in health insurance too (2+ / 0-)
    Recommended by:
    ChadmanFL, onionjim

    as seen in this story from Philadelphia:

    "The region's largest health insurer anticipated enrolling 100,000 new members in Pennsylvania and through AmeriHealth New Jersey when the Affordable Care Act marketplace opened in October.  As of April 30, the company had signed up a total of 283,000 members in new plans, almost three times as many as it expected. And 89 percent of them have paid their premiums.....

    "Underestimating its enrollment caused a domino effect for Independence. Difficulty getting through on the phone led to a 400 percent surge in e-mails that overwhelmed the website, causing a 550 percent increase in Facebook comments complaining about being unable to get through.   "Every time we turn a corner, the volume [of new members] increases," Roker said from Independence's state-of-the-art call center in Spring Garden. "We're always busy, but this has been beyond our wildest dreams."

    "...To help ease the backlog, Independence initially increased its phone staff by 20 percent. When that proved insufficient, the company added more people, eventually increasing its customer service staff to 600, a rise of 50 percent.

    The spirit of liberty is the spirit which is not too sure that it is right. -- Judge Learned Hand, May 21, 1944

    by ybruti on Wed May 14, 2014 at 06:49:49 PM PDT

  •  Don't Blame the ACA (1+ / 0-)
    Recommended by:
    Chas 981

    Every criticism of the ACA is itself a pre-existing condition.  No one ever had their premiums go up?  No one ever had their policy canceled?  No one ever had problems finding a doctor?

  •  I think there are some temporary wrinkles (0+ / 0-)

    in which providers will accept which plans.  A couple of my friends in CA switched over to plans from state exchanges after previously having had group coverage through work.  The insurance company is still the same (Blue Cross), but the previous providers will no longer see them as patients because the providers are refusing to take Covered CA plans.  I'm not sure if it's concern about reimbursement rates, admin overhead, and/or politics.  The end result is my friends' health-care costs have gone down...but they are having a heck of a time finding doctors.

    This may just be an isolated incident, and hopefully it will iron out soon.  I have other friends elsewhere who are taking advantage of ACA to leave soul-sucking jobs and pursue entrepreneurial options...very cool.

  •  As a primary care doc I would add that... (2+ / 0-)
    Recommended by:
    otto, slouchsock

    this is largely true, though a bit misleading.

    The U.S. primary care system, such as it is, still is intensely stressed. The average age of family physicians, for example, is well north of 55 years, and the number of new medical school graduates going into family medicine is well below the replacement rate. Reimbursement remains far below that for procedural specialties, which guarantees most graduates continue to vote with their feet and choose interventional cardiology or gastroenterology instead.

    Primary care has been able to accommodate the influx of newly insured patients for one reason: the malignant spread of high-deductible, high-copay, junk insurance over the last 4 years means many of my patients simply can't afford to come to the office to see me. Every day I have patients who no-show for scheduled office visits, then call to request their prescription refills. Who call requesting treatment over the phone so they don't have to make that steep copay. Who beg me to hold off on any testing until they hit their deductible for the year.

    So I have a few more spots in my schedule this week because patients who already have crappy insurance can't afford care, and are deferring it until they get really, really sick.

    Which is very uncool.

  •  My wife and I are both on Medicare. (0+ / 0-)

    No problem in getting appointments.

    When the F**K are we going to wake up and do something about this mess?

    by keyscritter on Wed May 14, 2014 at 06:57:40 PM PDT

  •  It's the Christian/Muslim thing (1+ / 0-)
    Recommended by:

    WHile they are saying that not enough people have signed up, they are simultaneously going to say that the nation's doctors are overwhlemed by these unwashed subsidy recipients!


    by otto on Wed May 14, 2014 at 06:58:34 PM PDT

  •  This whole thing is a liberal plot. (1+ / 0-)
    Recommended by:

    Here's the plan: Get 'em hooked on free government stuff, and then bingo! You have socialism. That's my Rush impression.

    I am very happy with the new direction, and being in Vermont, we are supposedly going to be the Guinea pigs for single payer. What? Vermont? Our roads are done, bricks coming from the town hall building walls.

    Never the less, this is exciting, but I can't actually see how they can do it, because, as you know, we can't has nice things.

    A true craftsman will meticulously construct the apparatus of his own demise.

    by onionjim on Wed May 14, 2014 at 07:01:04 PM PDT

  •  Job Growth for Doctors (0+ / 0-)

    Why is it bad that we've redirected our economy's dollars away from employing more insurers/bankers into employing more doctors/nurses/practitioners? Because we're healthier and able to work with fewer sick days?

    "When the going gets weird, the weird turn pro." - HST

    by DocGonzo on Wed May 14, 2014 at 07:26:50 PM PDT

  •  So let me get this straight. Repugs are bitching (0+ / 0-)

    about fictitious long wait times because their SOOOOO concerned about people getting good healthcare.  So their solution is to take away healthcare from millions.  And I'm supposed to take these idiots seriously?

    •  Survival of the fittest patient (0+ / 0-)

      Don't worry. We will NEVER be able to 'get this straight'. Pretzel logic does not straighten out unless the brain processing is as twisted as that.

      "I feel a lot safer already."--Emil Sitka

      by DaddyO on Thu May 15, 2014 at 12:41:50 PM PDT

      [ Parent ]

  •  Maybe because my wife and I live in (0+ / 0-)

    the Twin Cities, which have some of the very best hospitals, clinics, and medical staff in the country, it should not come as a surprise that I, as a new Medicare enrollment, had an appointment on 2 January as did my wife, who had registered under MNSure.  We've both had our medical problems, COPD, chronic pain, prostate problems, etc., but thus far we've experienced no real delays.  I've gotten in to see one of the best urologists in the state after only a three week wait, and she's had a bone scan, MRI, and mammogram, plus dental work, which is included in the cover she has gotten through Medica.  Out of pocket expenses have been relatively minimal, aside from hyperexpensive inhalers that have no generic equivalent.  All in all, we've been remarkably well pleased.  But I will say this:  I'm damned glad we live in Minnesota and not in almost any other state in the country.  It may be cold here in winter, but they've got their medical act together.  

    -7.13 / -6.97 "The people never give up their liberties but under some delusion." -- Edmund Burke

    by GulfExpat on Wed May 14, 2014 at 08:42:24 PM PDT

  •  On the road to wellness again. (0+ / 0-)

    I went to Louisiana after the Spill in 2010 hoping to find work, my business supplying biomedical researchers with purple sea urchins (genomics and the Sea Urchin Genome Project) and Aplysia (sea hares for neuroscience, learning and memory) was handed to the 300 commercial sea urchin divers who thought I was taking from them by Arnold's minions. I studied Aquatic Ecology at UCSB in the 80s.

    I didn't find any decent work and even though I had relatives there, one was Supreme Court Justice under Huey Long, I didn't connect with them. I had a decent education and many years of experience and before I had been disabled I ran a GC/MS lab for detecting and quantifying EPA Priority Pollutants.

    But I could not find work helping the Gulf remediate after the Spill. It was corporatized and jobs were political plums.

    So I settled into New Orleans for awhile and worked as an extra on TV and films. It was fun but I couldn't get by even in N.O. Rents doubled after the Hurricane and the industry was too unpredictable.

    In addition I needed getting looked after by a dermatologist. I spent my days outdoors and I have fair skin so I needed some surgery and a drug called FU5 that kills pre-cancers and some non-malignant ones when they're small. Jindal killed the hospital system in Louisiana though and I couldn't go there day after day for a year to get care so my skin cancer kept growing.

    Under Huey Long people in Louisiana were guaranteed care no matter what their income but Jindal took that out. I'm so glad that I did't go into teaching there since he killed that next.

    So I had to wait four years before getting it fixed by moving back to California. I had trouble with getting forms processed and occasionally mis-communication at the hospital where I got treatment but the system set up by Obama worked and I got surgery, much more than I would have needed four years ago, and I'm recovering. Thanks, Mr President, and now I can actually pass a physical and find a job if I can't rebuild a business. The ACA worked. The surgeon was highly skilled and scarring on my chin fits with the line of the chin, not that I care that much. On my chest and back the scars are easily noted if I take off my shirt, but I no longer go the beach without a wet suit.

    I want to rebuild, collecting purple urchins off the Santa Barbara Channel actually helped reduce a scourge, urchins routinely destroy kelp beds in So Cal since there were few predators. Otters were coming back but near UCSB otters were temporary due to the conditions and the nearby oils seeps. Sea hares are used according to size and adults were not used by my clients so collecting them would be stupid, only sea hares of a certain size were needed so ones too large or too small were released on another reef that I didn't use. Best of all they can be cultured. There's a facility in Miami but they're animals are inferior to wild ones because they didn't have enough challenges for the animals to learn and compete. They're couch potatoes.

    Well, I won't stay in California and Aplysia aren't found too far out of the state. Some in Oregon but that's too remote. There are things in Washington that I could do. Sea grass could be cultivated to remove CO2, as well as other algae. Oysters can be grown. There are other things that aren't abusive to the environment.

    But the main thing is I am whole again and I can thank the ACA and President Obama for it. Plus I can get insurance in a place like Washington as well. The only thing holding me back is my imagination!

  •  more info on Colorado please (0+ / 0-)

    could you point me toward more specifics on Colorado--where are the problems?
    There are some counties that do not have enough providers, but I wonder what's changed and where.
    The way our health insurance regions are divided doesn't always reflect accurately the travel distance for health care.

  •  My parents can't get appointments (0+ / 0-)

    Sorry to have to play devil's advocate here, but my folks told me that they're getting rejected by most of the doctors they need to see here in Orlando, FL. The Blue Cross/Blue Shield Platinum plan they got on through the ACA is costing them 800 dollars a month, and now they've decided to stop paying it because they can't get any appointments. They've gone through the website to find doctors, but when they call the office staff tells them that they're no longer taking those ACA plans, even though the website says they do. I'm not concern trolling here. I'm really pissed off about this, and am not sure if it's an organized effort on the part of the medical community in this wingnut state.

    I'm voting for Hillary in '16 and I'm hoping beyond hope that she get's behind a public option that opens the door to Medicare for all.

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