We all witnessed the disastrous rollout of the Healthcare.gov website which crashed almost immediately after going live.  The reason according to the Department of Health and Human Services was the huge demand for access to the insurance exchange.  I expect that the website issues (or many of them anyway) will eventually get fixed, but then what?  Is the delivery system ready or will it crash too?  Consider  the article published on NYTimes.com today “Medicaid Growth Could Aggravate Doctor Shortage“.  And, the Medicaid expansion is only a small part of the problem.  Those of us familiar with the healthcare delivery system have known for a long time that there’s an impending and massive physician shortage on the horizon, particluary in primary care.  This was the case even before the passage of the Affordable Care Act and was largely due to the expected healthcare needs of the Baby Boomer generation.  It’s a pretty fair bet to assume that adding 30 million more insured patients to an already stretched system will result in some kind of system failure, but what is that likely to mean?

Patients who do not have insurance or those with insurance but who can’t wait for the next available appointment with their physician have historically gone to the local emergency room.  Most commercial insurance provider agreements prohibit physicians from discriminating against patients, so under Obamacare, participating physicians will likely not be able to turn categories of patients away.  All patients will have the same access to the limited number of patient appointments each day.  This means longer waits for appointments for everyone.  Those who can’t or won’t wait for one of those appointments will likely head to the ER or one of the many urgent care centers now popping up around the country.  Physicians will still not be required to participate in Medicaid (although hospitals may require their employed physicians to participate), so ready access to regular primary care for the many newly insured patients under the Medicaid expansion program is not guaranteed.  Where will those folks go if they can’t find a private practice physician who accepts Medicaid?  Just a guess, but I imagine many of them will end up at the local ER.