The effect on peds is small.
The biggest change so far is that most of the Obamacare plans use much higher deductibles than employer based insurance uses. A lot of people are switching away from employer based plans to Obamacare plans, and instead of paying a $30 copay for a doctor visit, you have to pay the entire doctor visit cost out of your deductible. This incentivizes the parents to not bring their child to the doctor's office unless it is something more serious than runny nose and cough (maybe that's a good thing!)
The Medicaid increased reimbursements is a red herring. In 3 years those increased reimbursements will be phased out. It is a political ploy to help smoothe out the rough transition to Obamacare. Rest assured that in 3 to 5 years, those increased reimbursements are going away.
That's not the real problem however. The real problem is that if you are building a practice relying on these Medicaid patients, in 3 years when the reimbursements plummet again you will have to essentially build up your practice from scratch if you want to get back into the private insurance market. Building up a practice, regardless of whether you are general peds or a subspecialist, is no easy task. If you take Medicaid, it becomes very difficult to have any significant private insurance patients for 2 reasons:
1. Most state medicaid contracts require you to have an "all or nothing" approach. In other words, if you accept Medicaid, you have to give all medicaid patients "equal access" to your scheduling system.
2. If you give Medicaid patients "equal access" to your scheduling system, then it is virtually inevitable that your share of private insurance patients will dwindle down while your patient base becomes overwhelmingly Medicaid. This is due to the fact that Medicaid patients are desperate to find PCPs and there's a lot more of them relative to private insurance patients who are looking for new PCPs.
A colleague of mine shared his experience with this. His state temporarily increased Medicaid payments to 75 percent of Medicare a few years ago, so he started taking Medicaid patients as a way to "give back" to the community as he felt bad for poor kids who couldnt get into a doc. In 1 year, he went from 100 percent private insurance visits to less than 10 percent private insurance. He was absolutely inundated with Medicaid folks. When the state pulled back funding on Medicaid to previous low levels, he tried to go back to mostly private insurance but it took him a long time to rebuild that patient base because a good chunk of his private insurance patients left for other PCPs due to them not being able to get to the doc for visits in a timely fashion. When your phone lines are flooded with 5000 medicaid patients trying to get an appointment, there's no room left for the 500 private insurance patients to get in to see you. Eventually they start going somewhere else even if they like you.
Beware of the "bait and switch" strategy that state and federal governments use to screw over doctors.
