As predicted, pushback against the new Affordable Healthcare Act has already started. One major problem for its implementation and ultimate effectiveness is the States' ability to refuse to expand its current Medicaid program. For example, Texas Governor, Rick Perry, has already announced he will not be expanding the Texas Medicaid program to cover all individuals under 65 who make up to 133% of the federal poverty guideline. Even though this is a major problem for the law's ultimate effectiveness, it is not the only pitfall waiting around the corner.
Another and perhaps bigger challenge to the law's coverage mechanism is the fact that it cannot force doctors to accept new Medicaid patients. Medicaid has long been known in the medical service industry for not fully reimbursing for services. As a result, today, only 31% of Texas doctors are accepting new Medicaid patients according to a Texas Medical Association survey. In the year 2000 that number was 67 percent. With the amount of people who would potentially be added to Medicaid coverage under the new law, and the amount of doctors no longer accepting Medicaid patients, even if states were to adopt the full healthcare law patient will likely find it difficult to receive care simply because of a sheer lack of service providers. Essentially, there will be millions of people covered by Medicaid without a doctor willing to see them.
The law has attempted to encourage Doctors to accept new Medicaid patients by raising the reimbursements received to the same as that for Medicare patients. This raise, however, does not occur until 2013 and Medicare has also continued to cut Doctor reimbursement payments over the years making it also unappealing to physicians. The problem is that the Medicare rate does not take into account the actual cost of providing medical services to the doctor, i.e., (overhead, insurance, labor, etc). Instead, Medicare pays a flat rate per service at a level it perceives is adequate, even if the doctor takes a loss as a result of providing the service. Therefore, if the Medicare rate is an inadequate payment structure and all the Affordable Healthcare Act did to incentivise doctors to accept Medicaid is raise the Medicaid payment rate to that of Medicare, then the law has no incentive for doctors at all.
This is the big problem for Obamacare. Even if ever state in the country adopts every provision of the law, there will still be a problem with patient access to care.