Will there be enough Rhode Island doctors for newly insured?


Like an old joke sprung to life, there's good news and bad news about HealthSource RI (HSRI), the new health insurance marketplace in Rhode Island.

First the good news: Because of HSRI, tens of thousands of people will now have health insurance covering their doctor visits, many for the first time.

And the bad news? Because of HSRI, tens of thousands of people will now have health insurance covering their doctor visits, many for the first time.

That situation is ripe for major bottlenecks at doctors’ offices all over the state.

Government numbers have it that as many as 45 million Americans had no health insurance coverage last year. The Kaiser Family Foundation, the health industry's leading source for much of its data, estimates that out of a total population of about a million, around 124,000 Rhode Islanders were among those uninsured in 2012.

The Affordable Care Act, most commonly called ObamaCare, was designed to drastically reduce that number.

"The goal for HSRI is to have between 70,000 and 100,000 newly insured people in Rhode Island by the end of 2014," Dara Chadwick, the program's spokesperson, said this week.

These newly insured will come from an expanded Medicaid program that insures residents whose incomes are under 138 percent of Federal Poverty Levels, from those who were uninsurable in the past for health reasons (there are no health restrictions for insurance under the new law), and from those who had no employer-supplied health care benefit and simply chose to risk living without insurance. As of next year, people either get insurance or pay a fine.

Except for one brief website crash, Rhode Island's health insurance marketplace has been up and operating since Oct. 1. Phone lines have been open, and the new storefront on Royal Little has been open to answer questions and take applications.

As of Oct. 26, 9,687 accounts had been created and 3,762 applications processed and completed.

According to DoctorsElite, an independent clearinghouse for physician information, there were 7,254 active doctors in Rhode Island last year, or roughly one for every 144 residents. But just 1,115 of them are self-listed as "internal medicine, primary care" doctors, which works out to about one for every 900 people in the state.

Raw numbers can always appear dire, and the other 6,000 doctors include pediatricians, OB/GYN, family medicine practitioners and other highly popular categories. But adding another 100,000 people to the mix certainly doesn't ease an already crowded waiting room.

"I don't believe you'll hear any of our physicians say they cannot take more patients," said Colleen Kilmartin of Kent Hospital. She added, however, that may not be true for the whole state.

When asked if doctors in Rhode Island might have to stop seeing new patients because of an increase of health insurance recipients, Steven R. Detoy, Rhode Island Medical Society's director of government and public affairs, spoke plainly:

"I'm pretty sure it's true," he said. "Getting insurance does not automatically give you access to a doctor.

"We haven't trained enough primary care physicians in Rhode Island – or anywhere else, for that matter," Detoy said. "In Rhode Island, however, we're probably in better shape than the rest of the country because we do have a large number of Nurse Practitioners and PA's [Physician's Assistants], here."

The facts bear that out.

According to the Bureau of Labor statistics, as an occupation category, Physician Assistant has increased faster than any other over recent years.

There are other mitigating factors that will help sort out the health care crunch, Detoy said.

"First of all, not everyone will sign up at once. Come the first of the year when the new insurance is first in force, there will probably be some scheduling issues. But I'm optimistic about this," he said.

Since HSRI opened Oct. 1, the number of new insurance policies being issued has remained remarkably consistent at about a thousand a week.

"We expected the traffic will ebb and flow, but yes, so far it seems steady," Chadwick said. "The critical date is Dec. 15, we think. We've been advertising that that's the date you must enroll if you want your coverage to start on Jan. 1 – there's a two-week delay."

The enrollment period for this first year ends on March 31, 2014. After that, financial penalties will apply.

Rhode Island was one of 16 states (plus the District of Columbia) to set up and run its own health care exchange, or marketplace. The insurers are the commercial insurance companies that have been doing business here in the past: Blue Cross Blue Shield, Neighborhood Health Plan and United Health Plan. Tufts will start selling their health care plans through HSRI in 2015.

While the federally run marketplace set up for states who refused to take care of their own uninsured population has seen some well-publicized problems with computerized enrollment, HSRI has been virtually "glitch-free."

"We crashed the first day because of so many people visiting our website at the same time," Chadwick said. "But we were back up in about an hour."

HSRI maintains a website (healthsourceri.com), and has hired a staff of 75 to handle phone-in and walk-in traffic at a new facility on Royal Little, in Providence.


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