Can 3 million newly insured fit into current system?

California’s resounding success in enrolling residents in Obamacare health insurance policies and expanded Medi-Cal coverage—a total of nearly 3 million people—is bumping up against the next Big Question: can these new enrollees use their insurance cards to find adequate care?

It stands to reason that you can’t stuff 3 million new people into an existing system and expect everyone to get the same level of attention. But a recent panel discussion by top health policy experts offered some clues as to why a stampede to doctors’ offices may not be imminent.

For one, almost one third of those new enrollees don’t have their cards yet.  Medi-Cal has a backlog of 900,000 applications, and while it is slowly overcoming processing problems, it also has a steady stream of new applications so the backlog is barely receding.

Second, many health care providers for lower-income residents are beginning to kick up the scope of practice of front-line health workers – nurses, physician assistants, and pharmacists—to help ease the pressure on physicians.  Individuals with chronic diseases such as diabetes may in fact be better off with regular visits to a pharmacist than waiting for months to see an M.D.

The panelists at a May 19 Public Policy Institute of California forum--California Health and Human Services Secretary Diana Dooley,  California HealthCare Foundation president Sandra Hernández,, and Los Angeles County Health Director Mitchell Katz--all agreed that access to care is the next challenge as health reform continues its roll out.

They seemed to indicate that as the pressures on providers increase, the definition of “care” will change.

“We want care that brings health,” Katz said. By that he meant that high-cost medicine needs to be supplanted as the gold standard of care by a regime of lower cost preventative measures to keep people out of hospitals.  

“Cost is the elephant in the room,” said Dooley.  Her department has pushed Medi-Cal into managed care arrangements, replacing fee-for-service payments with per-capita contracts that make providers responsible for patient health.

Those contracts mean patients have much less choice of doctors and hospitals, which can also translate into an access squeeze.

But that’s probably unavoidable, when millions who were shut out of health insurance are now getting it.               

“The system won’t be able to function as it did in the past,” Dooley said. 



Roger Smith

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Roger Smith

Roger Smith, editor, joined the Center in 2013 after 35 years as an editor and reporter with the Los Angeles Times. He became national editor of the Times the week after Barack Obama was elected president, and closely supervised coverage of the Affordable Care Act from inception to implementation. For a decade he was editor of the Column One feature on page one, the Times’ premier spot for narrative stories. He also directed coverage of two presidential campaigns, and was principal editor on two Pulitzer Prize-winning projects. Before becoming an editor he reported for the paper’s business and metro sections. He joined the Times from Business Week magazine. He is a graduate of the USC School of Journalism.Phone: 818-512-5123Twitter: @rilmotsEmail: Rogersmi at (link sends e-mail)

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