EXCLUSIVE: ‘Crowd Out’ Turning One Arizona Doctor’s Office Upside Down

Part One of a five part series on how Obamacare is already impacting doctors, and what it means to you.

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This is Part One of a five part series titled “Do No Harm:  Inside Obama’s War on Doctors.” Be sure to check out Part Two, Part Three, Part Four and Part Five.

Thirteen years ago, Dr. Richard Benedict started his practice in Fort Mohave, Arizona.  A graduate of Arizona Medical School, Benedict has spent almost two decades protecting the health of expectant mothers, delivering babies and caring for women in the specialty of obstetrics-gynecology to correctly diagnose and treat their health care issues.

His wife, Mardi, is a key member of the business side of his practice as the office manager.  She handles accounts payable and accounts receivable, works with insurers and the state and, not the least of which, works closely with their patients.

It was a good, successful practice.  All was well.

In 2009, the federal government passed the Affordable Care Act and a few years later, Arizona’s Republican Governor Jan Brewer forced the state to expand Medicaid under Obamacare.

It wasn’t long before the repercussions began to manifest themselves.

Medicaid Enrollees Jump

All the Medicaid programs in Arizona fall under the Arizona Health Care Cost Containment System (AHCCCS).  When Arizona expanded Medicaid under Obamacare, it raised the eligibility for Medicaid to 133% of the poverty level.  New Medicaid recipients began flooding in.  According to the Arizona Daily Star, enrollment in AHCCCS “jumped by 22 percent from March 2014 to March 2015.

Currently AHCCCS shows 1.8 million enrollees, up from 1.3 million enrollees in 2013, an increase that requires AHCCCS to increase the size of their population chart:

AHCCCSThat’s close to one in four Arizonans on Medicaid.

Prior to Obamacare, Mardi said the majority of practice’s patients were private pay.

Today, it’s much different.

“We went from a 60 percent private pay / 40 percent Medicaid to 70 percent AHCCCS / 30 percent private pay,” Mardi said.

That is an incredible turnaround.

Mardi said it isn’t just more people are eligible and getting enrolled in AHCCCS.  Despite President Obama’s promise that if you liked your health care plan, you could keep your health care plan, many Arizonans are losing theirs altogether or seeing those private policies priced out of affordability.  And the government was recruiting.

Government Recruiting Medicaid Enrollees

“A lot of our patients switched to Medicaid,” she said.  “I have a friend who has three children.  They are self-employed.  She said to me, ‘We were offered AHCCCS.  It’s very appealing, but we didn’t take it.'”

She said her friend told her, “That’s what’s happening.  They’re being offered, ‘Hey, you don’t have to pay anything for this.  So you can stay on your insurance or you can go to AHCCCS.'”

Not everyone rejected the offer.  When presented with the opportunity to have health coverage and not pay premiums, some left their insurance plans behind and signed up for AHCCCS.

This is known as “crowd out.”  This “occurs when people who are already covered by employer-paid or individual insurance drop that coverage to take advantage of a public insurance option.”

This is a common occurrence, as noted in a 1996 study that showed that between 1987-1992, “approximately 50 percent of the increase in Medicaid coverage was associated with a reduction in private insurance coverage.”

The authors of that study was David M. Cutler and Jonathan Gruber, both advisors to the Obama administration.

The problem with the flip-flop of the Dr. Benedict’s patients is more than one of crowding out.  It’s also exacerbating the doctor shortage in America.

According to the Kaiser Family Foundation, 30 percent or more of Arizona’s population lives in Primary Care Health Professional Shortage Areas.


A 2014 report by the U.S. Department of Health & Human Services’s Office of the Inspector General found:

slightly more than half of providers could not offer appointments to enrollees. Notably, 35 percent could not be found at the location listed by the plan, and another 8 percent were at the location but said that they were not participating in the plan. An additional 8 percent were not accepting new patients. Among the providers who offered appointments, the median wait time was 2 weeks. However, over a quarter had wait times of more than 1 month, and 10 percent had wait times longer than 2 months. Finally, primary care providers were less likely to offer an appointment than specialists; however, specialists tended to have longer wait times.

Increased enrollment in Medicaid across America will accelerate the doctor shortage, impacting everyone who needs access to health care.

Kaiser Foundation advocates for increased use of nurse practitioners to manage the increase in “already sharp strains to primary care in our health system.”  Mardi says they have hired one.  But she notes a nurse practitioner is not a doctor and is limited in what they can do.

This small Fort Mohave practice is still reeling from the dramatic change.

Tomorrow, we’ll examine how the increase in Medicaid patients has caused revenue to spiral downward, due to ridiculous reimbursement issues, while their costs continue to rise.


The complete SamePageNation’s exclusive “Do No Harm:  Inside Obama’s War on Doctors.”

‘Crowd Out’ Turning One Arizona Doctor’s Office Upside Down
Part One of a five part series on how Obamacare is already impacting doctors, and what it means to you.

Arizona Doctor Reveals Medicaid Nightmare: Zero Dollar Checks, Insufficient Funds
“I think other people are just afraid to speak up. That, and they’ve just given up fighting.”

Obamacare Crushing This Arizona OB/GYN’s Practice As Revenues Fall By Half
“The number of patients has increased, but we’re getting less for them than before.”

Obamacare Compounds the Stress of an Already Stressful Job
“I’ve seen my husband go from someone who loved what he did, to not so much anymore.”

AZ Doctor Points The Finger At Obamacare For Doctors Quitting

“We’ve been so demonized by Obama and Washington DC, that now we’ve got big targets on our back.”

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1 comment

  1. Rich Weinstein Reply

    By understating Crowd Out (Gruber and CBO projected 2%) the cost of the ACA was also understated. This is one of the gimmicks used to make the ACA appear to be deficit friendly.