10 states where doctors love commercial plan patients

Government researchers have come out with a report that hints at how functional each state’s health care system really was in 2013, before the Patient Protection and Affordable Care Act (PPACA) public exchange and Medicaid expansion programs took effect.

Esther Hing and two other colleagues at the National Center for Health Statistics (NCHS) have published data showing the percentage of office-based physicians in each state who were accepting new Medicare patients and new Medicaid patients.

Medicare is a national program. For Medicare enrollees, state-to-state variation in the percentage of physicians taking new patients seems to have more to do with population differences than with state insurance regulations.

The percentage of Medicare physicians taking new patients varies within a reasonably narrow range, from 75.5 percent in Hawaii to 95.2 percent in North Dakota.

Variations in commercial enrollees’ access may reflect states’ efforts to manipulate commercial health care costs and health insurance rates, but, there, the range is about as wide as in the Medicare market, with a low of 75 percent, in Hawaii, and a high of 94.9 percent, in Minnesota.

Because states play a direct role in setting reimbursement rates for Medicaid providers, and coming up with the cash to pay the fees, state-to-state variations for Medicaid enrollee access are much bigger. The percentage of physicians taking new Medicaid patients ranges from high of 96.5 percent in Nebraska down to less than 40 percent in one state.

For Medicaid enrollees in the states in which the percentage of doctors taking new Medicaid patients is much lower than the percentage taking new commercial coverage patients, the benefits state Medicaid programs promise may seem like a mirage.

For the agents and brokers selling commercial coverage, information about the gap between commercial enrollee provider access and Medicaid enrollee provider access could be a powerful selling point.

Small employers may be tempted to send higher-income employees to the public exchange system, and lower-income employees to Medicaid. Why not do that? In some states, the answer may be that qualifying for Medicaid is not necessarily the same as getting access to health care.

Hing and her colleagues did not give long-term care (LTC) provider access data in the new report, but LTC planning prospects might be interested to see how hard getting a doctor can be for Medicaid enrollees.

We tried to give readers a sense of how big the gap is in each state by computing a “commercial advantage” index.

We started by calculating the gap between the percentage of doctors taking new commercial patients in each state and the percentage taking new Medicaid patients.

To adjust for state characteristics that might affect a state’s entire health care market, not just the commercial market, and not just Medicaid, we then divided the commercial patient/Medicaid patient access difference by the percentage of physicians in the state who were taking new Medicare patients.

For the 10 states in which patients with commercial coverage seemed to have the biggest edge in finding doctors over patients with Medicaid coverage, read on.