Ronda Kotelchuck

Avoiding the Side Effects of Universal Coverage

If ever there was evidence that expanded coverage must proceed hand-in-hand with increasing access, it comes with the example of Massachusetts -- a state that took bold leadership in providing universal coverage, but is now suffering from the side effects of that decision.

To be clear, universal coverage is an absolute must, both in New York and around the country. It is insufficient, however, if we are to reach our ultimate goal—universal access to needed and appropriate care. Assuring access must proceed in tandem with coverage, lest a slew of newly insured -- and currently insured -- patients be left without any sources of care. This is exactly what has happened in Massachusetts.

In a recent New York Times front page story entitled, "In Massachusetts, Universal Coverage Strains Care," Kevin Sack wrote "Now in Massachusetts, in an unintended consequence of universal coverage, the imbalance [between the relatively small supply of primary care physicians and the demand for their services] is being exacerbated by the state’s new law requiring residents to have health insurance."

This "access gap" prompted Dr. Patricia A. Sereno, Massachusetts state president of the American Academy of Family Physicians, to say that that increased coverage without a similar increase in access "is a recipe for disaster...It’s great that people have access to health care, but now we’ve got to find a way to give them access to preventive services. The point of this legislation was not to get people episodic care.”

“It is a fundamental truth — which we are learning the hard way in Massachusetts — that comprehensive health care reform cannot work without appropriate access to primary care physicians and providers,” added Dr. Bruce Auerbach, the president-elect of the Massachusetts Medical Society in a speech to Congress in February.

Here in New York, we can avoid a similar fate, but we must act quickly to build on the primary care reforms enacted by Gov. Paterson and the state Legislature in the 2008-2009 budget. This year, new investment totaled $240 million in increased primary care reimbursement and enhancements and in the Doctors Across New York program which encourages recent medical school graduates to go into primary care in high-need areas. At the same time Albany is moving forward to insure all children, and, eventually, all New York residents.

This is an absolute formula for success; a system where New Yorkers will have both access and coverage.

This is only a beginning, however, and success depends upon building public awareness and support for completing the agenda. The State’s initiative represents the first year of a multi-year phase in. For example, no future increases were funded for Doctors Across New York program. Similarly, the move to improve reimbursement for primary care doctors in community health centers, private offices and hospitals is unprecedented but represents only the first year of a four-year phase-in.

Between 2002 and 2006, three major areas of New York State -- the North Country, Western New York and Central New York -- experienced significant losses in of primary care doctors, according to the Center for Workforce Studies. This year's budget will help these areas reverse the trend, but it won't push them over the finish line.

Similarly, while a significant number of children will newly receive coverage, that trend has yet to reach a huge majority of New York adults, meaning that even if the measures meant to encourage new doctors to go into primary care are adequate this year, that need will further swell in years to come.

To ensure that New Yorkers don't suffer the same fate that many of those in Massachusetts--owning an insurance card, but having no place to use it—it is critical that the progress made this year be the beginning, and not the end, of increasing primary care access.

Ronda Kotelchuck: Author Bio | Other Posts
Posted at 7:19 AM, May 14, 2008 in Health Care
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