With Medicaid rolls ready to explode once Obamacare comes into full effect, it is significant to note that one in three US doctors say they will not accept any new Medicaid patients. And those are the ones who are willing to admit it.

Millions of new patients and a third fewer doctors. What does it add up to?

Washington Post:

There are a few interesting points to draw from this. The first has to do with what this will mean for the health law's insurance expansion. As Avik Roy pointed out a few weeks ago, states with Democratic governors actually tend to have lower reimbursement rates. Faced with crunched budgets, some have chosen to cut provider payment rather than reduce services.

That could mean that the states with the highest likelihood of expanding Medicaid might be those with the lower reimbursement rates - and fewer doctors willing to accept these patients by proxy. That could prove true in a state like California, where 1.8 million residents are expected to gain coverage - but fewer than 60 percent of providers accept new patients in the program.

It could also speak to the importance of some of the payment increases in the Affordable Care Act. The law increases Medicaid reimbursements for primary care doctors to match those of Medicare providers. That means that everyone on the right side of this chart will move over to the left. And that could entice more providers to participate. Decker estimates using this data set that it would raise the Medicaid participation rate to 78.6 percent, an 8.6 percent increase from where it stood in 2011.

How long it would stay that high, however, isn't clear. The payment bump only lasts for two years - 2013 and 2014, although some interest groups already have their eyes on an extension. It only goes to primary care doctors, meaning that specialty providers will not get any more financial incentives to open up their doors.

The key then, is Medicaid reimbursement. As long as a doctor or hospital isn't losing money, they will probably accept new patients.

But as the article points out, federal dollars will only last two years, which means states will have hundreds of thousands of Medicaid recipients for which they will be on the hook for either keeping the high level of reimbursement once the money from Washington dries up, or cut the rates and watch doctors bail out.

Of course, to "fix" this, the Feds will continue to subsidize the increased reimbursement rates. This was apparently the plan all along. The two year funding was put in to reduce the initial 10 year costs and fool the public into thinking Obamacare costs less than it actually will.

Not a bug, a feature.