Medi-Cal patients face hurdles to specialists in northern California

Jeff Lobosky, a Chico neurosurgeon, has had to turn away Medi-Cal patients due to the influx of new enrollees under Obamacare. Photo: Kyle Delmar/CHR

Unlike many specialists in Northern California, neurosurgeon Jeff Lobosky accepts Medi-Cal, California’s insurance program for the poor.

But the Chico doctor has been forced to turn away some Medi-Cal patients this year, because of the influx of new enrollees under the Affordable Care Act.

This conundrum is just one of many that doctors and patients in the Chico area and statewide are facing as Obamacare rolls out.

The ACA is providing coverage to millions of low-income people nationwide through Medicaid, but there weren’t even enough doctors for those in the program before. Medi-Cal is California’s Medicaid program.

“It will get them a card, but it won’t get them care,” said Lobosky, who outlines his concerns in his 2012 book, “It’s Enough to Make You Sick.”

As of Jan. 31, more than 1.6 million California residents had signed up for either Covered California health-insurance plans or Medi-Cal. In Northern California, some of those patients are finding health care, but many aren’t.

Julie Light is one of the lucky ones. A part-time substitute teacher, the Corning woman had been getting care at a local clinic that accepted cash payments on a sliding scale. When she signed up for Obamacare, she continued to use the clinic.

At her first visit since getting her insurance card, she saw a physician assistant and got some lab work done. Her co-pay was $3.

The clinics are rapidly filling up, however, as more people obtain ACA coverage. In Chico, Northern Valley Indian Health’s East Avenue clinic is seeing six to eight new patients a day, said site manager Beya Villegas. The clinic is “close to capacity,” she said, and the pressure to see more people “has taken a toll on the clinic. … I wonder where patients will go when we fill up.”

The Chico Children’s Center, a pediatric clinic run the same organization, is also full. “We’re probably booked out six weeks for some providers,” Villegas said.

The number of patients these clinics can see depends on the number of doctors, physician assistants and nurse practitioners on staff. It’s not easy to find qualified people who want to work in a clinic setting. “God, no,” Villegas said. “Normally it takes six months to a year” to fill an opening.

The largest comprehensive clinic in the Chico area is an Ampla Health facility on Cohasset Road, which offers dental as well as medical care. It recently underwent a major remodeling and expansion, but it’s now at capacity.

That doesn’t seem to faze Ampla’s CEO Benjamin H. Flores. Ampla has 12 clinics spread among rural towns such as Orland, Willows and Gridley, and many of them are not yet at capacity. Besides, Flores said, “We will continue growing and expanding services as demand requires.”

Flores’ optimism echoes that of Anthony Wright, executive director of the consumer-advocacy group Health Access. The hope, he told the California Health Report last June, is that if “you create a lot more paying customers by getting them insured … the market will adjust in terms of having more [doctors] there.”

Maybe so, maybe not. Richard Thorp, a primary-care doctor in Paradise and president of the California Medical Association, points out that the historic problem with Medi-Cal — its low rate of reimbursement — has not been fixed under the ACA.

An office visit is valued at $23 or $24, he said, “about what you’d pay for an extra-large pizza.” The rates are so low, he added, that every Medi-Cal patient is a money loser for his or her doctor.

The rates under Covered California’s insurance plans aren’t high enough either, Thorp said. The most affordable “bronze” plan reimburses at 70 percent of the same insurance company’s commercial rate, which in turn is lower than the Medicare reimbursement rate, he said.

Is it any wonder, he asked, that doctors aren’t eager to accept new Medi-Cal and Covered California patients? “Doctors are in business,” he said. “They have significant overhead. They have to make decisions that enable them to stay in business.”

California faced a shortage of primary-care doctors long before the implementation of the ACA. It has been especially acute in rural areas, where many family doctors are retiring and not being replaced.

The trend is to make increased use of doctor surrogates — physician assistants and nurse practitioners — to compensate for the physician shortage by handling uncomplicated cases under a doctor’s supervision.

Even if the shortage of primary-care physicians is solved, it won’t make specialists any more willing to accept Medi-Cal or ACA patients.

Just recently, Lobosky and his partners at Northstate Neurosurgical Associates received five or six referrals from the Redding area in one week. All were Medi-Cal patients who had been turned away by local neurosurgeons.

As the Redding doctors knew, the Northstate neurosurgeons are the only ones in the area who accept Medi-Cal. In this case, however, Lobosky’s practice also turned away the patients. The office can barely afford to take Chico’s Medi-Cal patients, he said.

Is the ACA going to work? Lobosky is doubtful. “Obamacare is counting on the doctors to say, “Oh, screw it. I’ll see them,” he said.

“The costs are going up, up, up, and they’re going to stick it to the docs and hospitals.”

If Obamacare fails, Lobosky said, one group might benefit: supporters of a single-payer system, or Medicare for all. “But it’s far too early to tell,” he said.

In contrast, Ampla’s Flores is upbeat. “For us, it’s an exciting time,” he said.

This story was produced for the California Health Report in partnership with the Chico News & Review. 

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