February 22, 2013|By Kathleen Haughney, Tallahassee Bureau
TALLAHASSEE Brace yourself for longer lines at the doctor's office.
Whether you're employed and insured, elderly and on Medicare, or poor and covered by Medicaid, the Florida Medical Association says there's a growing shortage of doctors — especially specialists — available to provide you with medical care.
And if the Florida Legislature goes along with Gov. Rick Scott's recommendation to offer Medicaid coverage to an additional 1 million Floridians — part of the Affordable Care Act that takes effect next January — the FMA says that shortage will only get worse.
"Florida needs more doctors and it needs more nurses, and it needs them working together in teams," said Rebecca O'Hara, a lobbyist for the FMA.
About 15 million Floridians have health insurance today, and Obamacare, which requires most adults to have coverage by January, could add as many as 2.5 million more. One million would come through a potential expansion of the federal-state Medicaid program that Scott announced this week he was backing. The others would be the result of new mandates requiring employers and individuals to have insurance or be fined.
Currently, the state has 44,804 doctors, but about 5,600 of them are expected to retire in the next five years. And even though Florida has opened three new medical schools in the past dozen years, the state isn't producing as many doctors as it needs. Scott's budget this year has $80 million to fund programs to train 700 new residents a year, in hopes they'll remain in the state.
Of all patients, people covered by Medicaid may have the hardest time finding a doctor; only 59 percent of the state's physicians are taking new Medicaid patients, according to a Kaiser Health News study.
Committees in both the House and Senate have been meeting for the past two months to discuss implementation of the Affordable Care Act. On March 4, they expect to see two major studies by the Office of Economic and Demographic Research, one that looks at the overall economic impact of the health-care overhaul and another that simply examines Medicaid expansion.
Scott, however, has already made clear how he feels about that.
On Wednesday, he unexpectedly announced that he had reversed his earlier, adamant opposition and now wants a three-year expansion that would cover single adults and families earning up to 138 percent of the poverty line; the costs would be fully covered by the federal government. If the expansion is re-approved after three years, the federal government is committed to paying no less than 90 percent of the cost.
House and Senate leaders will begin their budget deliberations in the coming weeks, which will include the decision over new residency slots, along with the debate over whether to expand Medicaid. Many lawmakers have expressed opposition.
Sen. Joe Negron, R-Stuart, who chairs the Senate committee studying the AFA, said lawmakers have heard concerns about a potential physician shortage, but he said he did not believe that would be a "determining factor" in the committee's decision over whether to expand Medicaid.
One reason, he said, is the responsibility for coverage may soon be falling to private health insurance companies or physician groups.
The federal government this week gave Florida preliminary approval of a plan that would put most of Florida's current 3.3 million Medicaid recipients — and any added via expansion — in some form of managed care, either HMOs or doctor-run networks, by 2014. In order for HMOs or the provider service networks to get state-approved contracts, they must prove they can provide "adequate" care, which means patients must be able to see a doctor in a reasonable time.
"It's their responsibility to have network adequacy," Negron said of the private providers. "So, they'll be responsible for making sure people can get care with network physicians."
Negron also noted that the amount doctors will be paid for seeing Medicaid patients is rising, which may prompt more physicians to take them. As part of the health care law, primary-care doctors will be paid as much for a Medicaid patient as they are under Medicare, a 73 percent increase.
Health care advocates who back the expansion say they aren't worried either.
Greg Mellowe, policy director for health advocacy group Florida Chain, said the state needed to carefully watch the situation as it develops, but added, "We don't believe that there is a crisis brewing."
Mellowe noted that many uninsured already receive care — often in emergency rooms, which is more expensive — that hospitals aren't paid for. If many of these patients have insurance coverage, he said, hospitals may see an opportunity to shift resources to primary care settings.
Lawmakers are slated to return to Tallahassee the week of March 4 for the beginning of the 2013 legislative session. The studies from the state economists are also due at that time.
Negron said until the state can look at that information, it was impossible to say what direction the Legislature would take.
"It will be a judgment call to make on the right way to proceed for Florida's families and businesses," he said. "I just think it's too early to tell where either the House or Senate will come down on this."
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Number of doctors in Florida: 44,804
Number of people with health insurance coverage: 15 million
Number expected in 2014, including a Medicaid expansion: 17 million to 17.5 million
Percentage of physicians expected to retire in the next five years: 5,600