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California Academy of Family Physicians

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The California State Assembly recently passed AB 890, which would give “full practice authority” to nurse practitioners. But a California physicians group opposes the bill.
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Some state lawmakers are trying help Californians by expanding the number of Medi-Cal providers following the explosive growth of the state's health plan for the poor under the Affordable Care Act. California's Medicaid program now serves almost a third of the state's population.

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One year into the explosive, health law-induced growth of Medi-Cal, it appears one of the most alarming predictions of critics is coming true: The supply of doctors hasn't kept up with demand.

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As a federal "funding bump" expires, the payments California doctors receive for seeing Medicaid patients are dramatically decreasing. At the same time, the state is imposing a 10 percent fee cut that was approved in 2011 but is just now taking effect.

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Starting next year, clinics in rural and urban areas will begin seeing millions of newly insured patients, and face higher expectations to keep costs down. Clinics are trying to improve the odds of keeping these patients healthy, but many are too ill or resistant to altering behavior.

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Calvin Woodard and his white van are a lifeline for those who are unable or unwilling to keep important medical appointments. 'He has a rapport sometimes that we can't have,' says a nurse practitioner.

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Doctors say it will be virtually impossible to keep low-income patients with significant problems healthy and out of hospitals -- part of new government mandates under health reform and a linchpin for reducing medical spending -- without timely access to a specialist.

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Dr. Alice Huan-mei Chen is director of the General Medicine Clinic at San Francisco General Hospital, and an assistant clinical professor of medicine at the University of California, San Francisco. With a primary interest in how poverty, cultural differences and policy intersect to create barriers to care, Chen focuses on improving access to quality health care for health consumers with limited English skills.

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