People in Texas are significantly more likely than adults nationwide to report that it has gotten harder to see a doctor in the past two years. That’s one finding in a new poll from NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health.
Vera Brown has been stuck aboard the doctor merry-go-round for years now, trying to find an orthopedic surgeon who accepts her insurance. She doesn’t find the endless calls, questions or repetition amusing.
“When they say I’m not covered that means I have to put off having surgery,” she says. “And that begins to start messing with my health.”
Brown, who is 45, has already had one hip replaced. Now, the other is starting to feel numb. She used to be in physical therapy, but the clinic stopped accepting her insurance, which is provided by Medicaid. She gets around her South Dallas apartment with the help of a walker. With an 11-year-old son still at home and a fixed income, she says traveling is hard.
“If you have a little money and you can go to wherever doctor, that’s fine, but what about the ones that does not have the income, or the say-so or the know-how, to go about doing this?” Brown asks. “We just lost out. And that’s just not right.”
Almost one in five people in Texas says it’s gotten harder to see a doctor in the past two years. It didn't matter what kind of insurance they had. John Carlo, CEO of the nonprofit AIDS Arms in Dallas, says across the board health insurance plans have “narrowed” their networks – shrinking the number if doctors and hospitals patients can see.
“The health plans are contracting with fewer and fewer health providers and hospitals,” he says. “They’re using this as a cost control measure. So it’s very likely that someone who in the past has had a lot more access to specialists they’re not finding that anymore and they’re having to travel greater distances to find those specialists.”
About 70 percent of plans available on healthcare.gov in Texas are size small according to Dan Polsky of the University of Pennsylvania. Staying on top of which doctors are in or out of network is hard for administrators as well as patients. Carlo says his health agency has had to refer out patients who’ve been coming for years.
“Frankly, it’s a mess,” Carlo says. “We just see this so frequently where a patient comes in, they’re carrying a health plan card, it looks good, they double check and when they go to file the claim to be reimbursed they find out they’re not in the network.”
And if you do find a doctor in network, there’s the problem of actually scheduling an appointment. About a quarter of adults in Texas who do have a regular doctor say there’s been at least one time in the past two year where they needed care, but couldn’t see their regular provider. Most stay it was because the doctor didn’t have available times. Texas Health Institute researcher Dennis Andrulis says the Affordable Care Act has helped more than a million Texans get insurance, but the state has a severe physician shortage. In Texas, there are about 186 physicians for every 100,000 people, according to the Texas Medical Association. The national average is 236 per 100,000.
“The law is raising hopes for those who, in this state have been chronically uninsured for such a long time,” Andrulis says. “But then for those who are able to get insurance, they will find difficulty in accessing care.”
Andrulis, who is also Associate Professor at the University Of Texas School Of Public Health, says for people on Medicaid, the situation is particularly frustrating. First, Texas chose not to expand Medicaid under the Affordable Care Act, and the rate it reimburses doctors for care is very low. The result: physicians in Texas have little incentive to take on new patients. To recap, Texas is a state with six million uninsured people, few primary care doctors, skinny networks, and low reimbursement rates for Medicaid.
“These are the seeds and reality of frustration,” he says.
It doesn’t surprise Andrulis that the majority of Texans who can’t see a doctor in a timely manner go to the emergency room instead, according to the NPR poll.
As for Vera Brown, she uses a community health clinic where costs are low, supplemented by some medicine from her mother.
“She will give you a hug like no other,” Brown says. “It will sooth your soul, and when you get through it’s like everything just gone away.”
And for a minute, she can ignore the pins and needles in her hip, and pick up the phone to make a few more calls to find a doctor.