The Massachusetts Medical Society recently issued the latest in a series of reports on access to care in the state. Critics of the Federal Affordable Care Act seized on one part of the report to allege that under Massachusetts health care reform patients’ access to care—particularly primary care—is now more difficult. But there’s a gaping problem with that interpretation—the report itself does not say that. The report instead correctly points out two problems:
- The national trend of fewer medical school graduates selecting primary care as their specialty, including in Massachusetts
- The under-reimbursement by public and private insurance plans to primary care physicians for their services
Clearly, these two problems are interrelated, in Massachusetts as elsewhere, but what about the alleged problems with patients’ access to care, particularly primary care, under Massachusetts health care reform?
Well, here’s what the Commonwealth of Massachusetts had to say on the matter in its latest Health Care Key Indicators Report, released in February. This report did have interesting and relevant findings on access to primary care in the state. First, the number of adults reporting they have a personal care provider has gone up since 2006 when the Massachusetts health care reform passed. Second, the 90 percent of adults who now say they have a personal care provider leaves 10 percent potentially in need of a primary care physician.
But according to the Massachusetts Medical Society Report, 50 percent of physicians’ offices say they are accepting new primary care patients. So considering these two surveys together, we can say that 95 percent of adults either have a primary care physician or could easily have one if they called for an appointment.
Now, without a doubt a 5-percent gap in access to primary care issue is not trivial, but it does not undercut the overall success of the 2006 law. And the Massachusetts Medical Society report does not address the access issue in 49 other states. In fact, Massachusetts has more primary care physicians per capita than any other state in the country.
Indeed, the realities underlying the Massachusetts Medical Society report reinforce the success of the state’s five-year-old health reform law. According to the report, when the law passed in 2006 some primary care physicians had room for new patients in their practices. The newly insured have now filled these previous vacancies. This is a good and intended outcome where supply and demand are closer to equilibrium. As this successful outcome proceeds and practices become full, naturally a larger portion of physicians are not accepting new patients.
In fact, it is not a surprise that access to care has improved under Massachusetts Gov. Deval Patrick’s leadership. He appointed as his secretary of Health and Human Services a primary care physician, Dr. JudyAnn Bigby. Under her leadership a public-private loan forgiveness program was created for primary care providers who would practice in neighborhood health centers. This joint effort of the state legislature, Bank of America Corp., and the Massachusetts League of Community Health Centers has produced over 100 new Massachusetts primary care practitioners since 2006. These new recruits to primary care practices in the state now serve an estimated 200,000 new patients.
The Massachusetts health care reform is not perfect, but it was never intended to solve the nationwide shortage of primary care graduates from American medical schools. Nonetheless, the consequences of the new law are evident in 98 percent of our residents with health insurance.
Sen. Edward Kennedy (D-MA) would be proud.
Thomas Glynn is a Senior Fellow at the Center for American Progress, Adjunct Lecturer in Public Policy at the Harvard Kennedy School, and the former chief operating officer of Partners HealthCare in Boston.
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