Since Medicaid expansion began in January more than 300,000 Virginians have gotten health insurance. They’re visiting the doctor, getting prescriptions filled, and even accessing cancer treatment.
But that doesn’t mean everyone is able to get an appointment.
Waiting for the corn to ripen and for the boats to come in to dock. That’s the pace of life as summer draws to a close in Deltaville, on Virginia’s Middle Peninsula.
But at the Fishing Bay Family Clinic things have been busier than normal, says pediatrician Dr. Karen Ransone.
“I’ve probably seen back 15 to 20 patients. And these are patients that I’ve been seeing since they were born,” Ransone says. “But then had to stop coming in at 18 and now they’re back.”
They stopped because they aged out of Medicaid. They’re back because they’ve been able to get Medicaid again thanks to expansion.
All summer long this practice has seen plenty of new Medicaid patients. The older adults go to Dr. Sterling Ransone, Karen’s husband.
“I’ll get the kids, my husband gets the adults, the kids grow up, they go over across the hall to the other side. It’s truly a family practice,” Ransone says. “And with my husband having grown up here, we know everybody. They know us.”
Which is why they try not to turn anyone away.
Luckily, the community here is enough of a mix of insured and uninsured patients that Dr. Sterling Ransone says it’s possible to take on more Medicaid patients -- even though the state reimburses doctors less for them.
“Seeing Medicaid patients is at a financial loss, absolutely,” Sterling Ransone says. “Right now we see enough of the commercial insurers that pay enough that we can make up that difference and it all balances out.”
It helps that their clinic is backed by a larger health system, Riverside.
“I have not gone home at night thinking ‘How in the world am I going to take care of all these people?” So no that hasn’t happened yet,” Sterling Ransone says. “Will that always be the case? I don’t know.”
Many of the providers interviewed for this story are asking themselves the same question.
According to a recent audit of Medicaid expansion services, access to primary care is strong throughout the state. But that’s measured by distance to a provider, not by how quickly you can get an appointment.
Across the Rappahannock River is the Northern Neck Free Clinic, where nurse practitioner Tamara Hall is already seeing some cracks in the system.
“Patients that have gotten approved for Medicaid, and eligible, decide that they want to….leave us,” she says. “And when they call to make an appointment (somewhere else) they’ve been told six months out is when the earliest appointment would be.”
So some of those patients have returned.
The board voted to become Medicaid eligible partially because they were worried there wouldn’t be enough local doctors, explains administrator John Wilson.
“The question always was how much local providers could absorb? So it’s just trying to make sure (patients) have a medical home,” says Wilson.
According to the Department of Medical Assistance Services, just over two-thirds of primary care physicians in Virginia say they’re willing to take on more Medicaid patients. But that still leaves about a third who won’t.
Including Mitchell Miller. He owns a private independent practice in Virginia Beach.
“I personally sleep better at night because I don’t have to answer to anybody. But I make less money,” says Miller.
He doesn’t accept Medicaid because he says his small business can’t afford to. He thinks any gaps in the system would get filled by doctors like him if lawmakers would raise Medicaid reimbursement rates even more.
“100-percent I believe that,” Miller says. “It breaks my heart to turn anybody away because of an economic factor. That just, makes my skin crawl...That’s just reality.”
The other reality is that the program is growing. By some estimates, another 85,000 people could still sign up. Demand on doctors and the healthcare system is only expected to rise.
This is part two in a look at Medicaid expansion, part one is available here.