Imagine, for the first time in your life, you are able to sign up for Netflix and have access to the movies you want, when you want them. You sign up, pay your monthly dues, then go to stream the movie you want, only to find out you don't have access through Netflix. Hulu has the movie available, but your subscription doesn't work with that service. Another option is to buy the movie, but that will cost a considerable amount more than you want to pay, which is why you signed up for Nexflix in the first place. If you can't get the movie you want, when you want it, through your Netflix account, what is the point of having it?

This is the problem that many are facing in Fresno, California. Only instead of movies, it's healthcare. With the arrival of the Affordable Care Act, many people who previously couldn't afford health insurance were overjoyed they would now be covered under Medicaid expansion. California was one of 31 states that opted to expand Medicaid under the ACA, with policy leaders predicting that over 100,000 more people in Fresno would have access to care within two years. Or so they thought.

At the beginning of 2015, two major events occurred that severely affected the Medicaid market in California. First, Assembly Bill 97, which imposed a 10 percent cut to providers. Medicaid reimbursements, finally took effect on Jan. 1, 2015, despite multiple attempts to repeal the legislation. Next, a federal program granting extra reimbursement to providers who deliver care to Medicaid beneficiaries ended, further lowering the amount providers are paid for Medicaid care in 2015. According to providers, the combined effect of these two moves meant it was now costing them to deliver care to the Medicaid population, which is also growing as a result of California's decision to extend Medicaid benefits to more individuals.

The predicament is not unique to California. At least 24 states did not extend the federal program increasing Medicaid providers, reimbursement, meaning physicians in these states also are dealing with lower reimbursements than in 2014. Of these 24 states, at least 12 of them, including California, New York, and Illinois also expanded Medicaid. If more providers decide the lower reimbursements are not enough and cease delivering care to the Medicaid population, areas with concentrated Medicaid populations within these states could face similar access problems as those currently facing Fresno.

The intent of the ACA and subsequent expansion of Medicaid was to increase healthcare access to the needy population, while reducing the overall number of uninsured. The reality of the situation is people are not getting the care they are now eligible for due to overcrowding under Medicaid expansion. Unless the government steps in and raises reimbursements or finds another way to increase provider participation in Medicaid, access will suffer and the ACA might actually do more harm than good in these areas across the United States.

Unlike a movie on a Friday night, healthcare is something that many of these individuals desperately need and, in some instances, is a matter of life and death. The people of Fresno know this story well as they have newly acquired insurance but cannot see the doctor. California has called special legislative sessions to try and fix the system; but in the meantime, individuals, health is suffering. The question remains: Will the people of Fresno and other areas where this is occurring have a happy ending or play a role in a developing tragedy?

Follow Evan Camden on Twitter @EvanCamdenDRG

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