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Medicaid enrollees strain Oregon; state expanded program under health care overhaul

By Gosia Wozniacka

Associated Press

Published: Wednesday, July 23 2014 1:20 p.m. MDT

Candles are displayed atop the Oregon state Capitol in Salem on Monday, Sept. 30, 2013 in honor of the building's 75th birthday.

Jonathan J. Cooper, Associated Press

Enlarge photo»

PORTLAND, Ore. — Low-income Oregon residents were supposed to be big winners after the state expanded Medicaid under the federal health care overhaul and created a new system to improve the care they received.

But an Associated Press review shows that an unexpected rush of enrollees has strained the capacity of the revamped network that was endorsed as a potential national model, locking out some patients, forcing others to wait months for medical appointments and prompting a spike in emergency room visits, which state officials had been actively seeking to avoid.

The problems come amid nationwide growing pains associated with the unprecedented restructuring of the U.S. health care system, and they show the effects of a widespread physician shortage on a state that has embraced Medicaid expansion.

It's too early to tell whether there will be lasting troubles associated with these immediate challenges. Overhaul supporters say they anticipated the need for more doctors and are already implementing solutions to improve access to care. They also point to the crush of new Medicaid enrollees as proof that their efforts are necessary and working.

Still, early indications show clear challenges associated with expanding Medicaid and establishing coordinated care networks, the centerpiece of Gov. John Kitzhaber's plan to reduce costs and improve care by focusing on primary care and keeping patients out of emergency rooms.

"As soon as people got insured, they all showed up at once, wanting to deal with the problems they couldn't deal with for years," said John Guerreiro, a primary care doctor in northwestern Oregon.

Under the federal overhaul, the state this year added nearly 360,000 people to the Oregon Health Plan, its version of Medicaid. It was more than twice the number projected and swelled the state Medicaid rolls to nearly 1 million people, about a quarter of the state's population.

Timothy McDaniel, a self-employed computer programmer from Springfield, gained Medicaid coverage in January and said it took him six months to find a doctor. He even went to an urgent care clinic seeking a wellness exam but was turned away, because the facility didn't provide such evaluations.

"It was rather frustrating because I'm getting older, I'm in my late 50s," McDaniel said. "I thought I had this health insurance. I wanted to use it. I wanted to get checked out, and I couldn't."

The flood of new enrollees like McDaniel has hit hardest in rural parts of the state, where the physician shortage is most severe. But problems have been reported from every corner, the AP has learned after contacting each of 15 regional coordinated care organizations, regional networks of doctors and nurses intended to see patients more often for treatment of small and chronic problems.

The coordinated care model has been championed by the state's Democratic governor, an early supporter of President Barack Obama's Affordable Care Act, and is unique to Oregon.

Five of the 15 regional coordinated care organizations declined to comment. The others reported a list of complications.

— Two regions have stopped accepting new patients, locking out more than 16,000 new enrollees in western and southern Oregon, state data shows. The new patients are still insured, but without a coordinated care network, they're on their own to find a doctor.

— Eight regions saw some practices, clinics and individual doctors close to new Medicaid enrollees.

— In five regions, thousands of enrollees haven't been assigned to a doctor or been in for their first medical appointment.

— Seven regions report that new patients are facing long waits for primary care visits, delays that can last months.

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