In partnership with The Texas Tribune, we're investigating the changes we're already feeling. And we found wait times that you may not be happy to live with.
A UT Health Science Center study out Tuesday suggests Houston's Safety Net Medican Center would have to grow 17 percent a year just to handle the expected increased need for doctors; that, at the same time our reporting partners at the Texas Tribune gathered data on Medicaid patients. In the statewide map, the darker the county, the more Medicaid patients.
In Harris County -- a federally declared shortage zone -- we have fewer Medicaid doctors than the state average. If the Supreme Court upholds the law, hundreds of thousands of Texans become eligible for Medicaid at the very time Texas doctors say they're considering closing their doors to some new patients.
Dr. Ana Torres runs a family practice in the Houston Heights. It's not big, it's not corporate -- she's the only doctor here. It's the kind of family doctor's office a lot of us probably remember from our childhood.
"I can walk to my house from here," said Dr. Ana Torres.
But a lot has changed since we were kids and the piles of paperwork hiding her assistants are the best proof of that.
"Health care is a mess," said Dr. Torres.
For years, Dr. Torres has accepted pretty much anyone who comes to the door. But now with universal health reform about to take effect, she is about to close the door to some of the poorest patients.
"I want to keep working. I want to be able to pay the bills," Dr. Torres told us.
Today there are 1.2 million uninsured people in and around Houston. The Harris County Hospital District estimates that 60 percent of them -- 700,000 people -- will get Medicaid coverage in January 2014 when the healthcare reform is fully implemented. Medicaid is a federal government safety net plan paid for mostly with federal dollars. It's good insurance, but to cut Medicaid costs it doesn't pay doctors that well.
She says she simply will not be able to see patients whose Medicaid insurance forces her to lose money. When we asked her where those patients will they go for care, Dr. Torres replied, "I think the public system is going to have to regroup and is going to have to open more clinics -- the Hospital District."
"That's an easy answer to give when you're not in that system," said Dr. Bob Trenschel with the Harris Co. Hospital District.
Dr. Trenschel works at HCHD where they're already expanding to deal with current backlogs. Here there are as many as 400 people who want appointments every day, but can't get one. That's 400 unseen patients every day.
"A very uncomfortable feeling; keeps us all up at night," said Dr. Trenschel.
But the sleepless nights are likely to get far worse because of health care reform before they get better. As more doctors opt out of Medicare and Medicaid, more patients will depend on the Hospital District for care, and on New Year's Day 2014 they'll almost all have insurance.
"Insurance doesn't always translate to access," Dr. Trenschel said.
Reform is creating an expectation that once everyone has insurance, everyone is guaranteed a doctor. What may instead be guaranteed are longer waits -- that's what happened when Massachusetts reformed its health care system. That's especially true if doctors aren't willing to see patients on Medicaid, which will become the largest insurance plan in town.
"There will be a time when we can say we no longer accept this insurance," said Dr. Torres.
Ten years ago, two-thirds of all Texas doctors accepted all Medicaid patients. Today, that number is just 42 percent. But to add some context, look at this from the Texas Tribune -- the chart shows Harris County is holding its own with doctors so far. About 79 doctors per 100,000 people stayed the same over time.
The flat line on the chart suggests doctors are coming here as the population grows. But what that doesn't show is that we rank 42nd in the nation for doctors, and just slashed money for doctor training in Texas.
Physicians groups tell the Texas Tribune the flat line may not look so good in a few years.