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Bracing for Medicaid expansion

More than two years remain before millions of low-income Americans gain Medicaid eligibility through an expansion authorized by the health system reform law, but it's already clear the overhaul will affect some states much more than others.

Certain states in the Northeast and Midwest already cover most or all of their poorest residents. So the health reform law's Medicaid expansion to 133% of the federal poverty level should pose relatively little strain to their safety nets.

But other states -- particularly in the South and Mountain West -- are bracing for a bigger impact. They will take on significant shares of the 16 million people expected to gain Medicaid coverage beginning in 2014, according to the Kaiser Family Foundation. About another 16 million people are expected to obtain private health coverage through insurance exchanges launching in 2014.

For these states, "primary care could be more of a problem in the future just because of the sheer increase in the demand," said Peter Cunningham, PhD, a senior fellow and director of quantitative research for the Center for Studying Health System Change, who wrote a research brief on the issue in March.

Challenged states -- such as Texas, Oklahoma, Mississippi and Idaho -- have limited numbers of physicians, but they already pay relatively high Medicaid fees to doctors in an effort to retain them. So a health reform provision that will raise Medicaid primary care pay to Medicare levels in 2013 and 2014 is not expected to lure many additional physicians in those states to accept new Medicaid patients, Cunningham said.

Texas, in particular, faces challenges because of its large uninsured population and low physician supply -- especially in rural areas, Cunningham said. "It will be an interesting state to watch."

Texas has the highest percentage of uninsured residents of any state: 24.6%, according to U.S. Census Bureau figures released Sept. 13.

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