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Obamacare enrollees strain Medicaid in Oregon

| Wednesday, July 23, 2014, 8:48 p.m.
In this July 11, 2014 photo, primary care doctor John Guerreiro checks on the records of a patient at a clinic run by the Virginia Garcia Memorial Health Center in Beaverton, Ore. The center comprised of nine clinics in northwestern Oregon, serveing 36,000 patients in Washington and Yamhill has been overwhelmed under the Affordable Health Care Act's Medicaid expansion. It has closed to new enrollees and is working through a backlog to assign thousands of patients to a doctor. (AP Photo/Gosia Wozniacka)

PORTLAND, Ore. — Low-income Oregon residents were supposed to be big winners when the state expanded Medicaid under the federal health care overhaul and established a system to improve the care they received.

But an Associated Press review shows that an unexpected rush of enrollees has strained the capacity of the revamped network that was endorsed as a potential national model, locking out some patients, forcing others to wait months for medical appointments and prompting a spike in emergency room visits, which state officials had been trying to avoid.

The problems arise amid nationwide growing pains associated with the unprecedented restructuring of America's health care system, and they show the effects of a widespread physician shortage on a state that has embraced Medicaid expansion.

It's too early to tell whether there will be lasting troubles associated with these immediate challenges. Overhaul supporters say they anticipated the need for more doctors and are implementing solutions to improve access to care. They point to the crush of new Medicaid enrollees as proof that their efforts are necessary and working.

Still, early indications show clear challenges associated with expanding Medicaid and establishing coordinated care networks, the centerpiece of Gov. John Kitzhaber's plan to reduce costs and improve care by focusing on primary care and keeping patients out of emergency rooms.

“As soon as people got insured, they all showed up at once, wanting to deal with the problems they couldn't deal with for years,” said John Guerreiro, a primary care doctor in northwestern Oregon.

Under the federal overhaul, the state this year added nearly 360,000 people to the Oregon Health Plan, its version of Medicaid.

For critics, these problems are the latest in a series of Oregon woes that include the state's decision to spend a quarter of a billion dollars on an online marketplace that failed under a litany of embarrassing problems and prompted a switch to a federal site.

But many state officials consider such issues as bumps in the road, far from anything that would threaten the overhaul. They say they're working on bringing all enrollees into the coordinated care system by year's end.

“I would consider it a rare success story for Oregon to absorb all these new patients,” said Leslie Clement, chief policy director at the Oregon Health Authority, a state medical regulating agency. “The primary care shortage is a national problem; it's not an Oregon issue.”

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