Money talks.

A temporary Medicaid pay raise that was part of President Barack Obama’s health law made it easier for poor adults to get appointments with primary care doctors, according to a study published Wednesday.

Paying more to doctors who participate in the federal-state insurance program for the poor usually improves access for patients, but the law’s two-year limit on the raise, its slow rollout and other regulatory problems made many skeptical about how physicians would react to the extra money — which in many states equated to a 50 percent pay hike or more.

The federally funded pay raise started in 2013 and ended Dec. 31, though a few states have continued the higher rates using their own money. The money was included in the health law to ensure there would be enough doctors to handle the surge of people who gained Medicaid coverage starting in 2014. Under the law, Medicaid would pay the same rates to family physicians, pediatricians and internists as Medicare, the federal health program for the elderly and disabled. The higher reimbursement was available whether or not states expanded Medicaid.

The 10-state study, published in the New England Journal of Medicine, found the availability of primary care appointments for Medicaid patients rose by nearly 8 percentage points after the raise was enacted, compared to only about a 1 percentage point increase among privately insured patients who were used as a basis for comparison.

States where doctors had the biggest pay raises — New Jersey, Pennsylvania, Illinois and Texas — all increased appointment availability by at least 10 percentage points. In each of those states, doctors received at least a 66 percent pay hike, the study said. The other states in the study were Georgia, Arkansas, Massachusetts, Oregon, Iowa and Montana.

“The two-year fee increase in Medicaid appears to have led primary care providers to make more appointments available for new Medicaid patients, at least in these 10 states,” said Genevieve Kenney, a senior fellow at the Urban Institute who worked on the report with University of Pennsylvania researchers.

The study did not examine whether the pay raise led more doctors to participate in the federal-state insurance program who were previously not seeing Medicaid patients. Most state Medicaid officials have said they did not see such a surge of new doctors.

The study was done by having staff posing as patients call primary care physicians’ offices and ask for new patient appointments. The calls were initially made in November 2012 through March 2013, before the pay raise was implemented in most states. A second round of calls was made from May 2014 through July 2014.

Medicaid enrollment has soared by nearly 10 million people in the past year as 27 states expanded eligibility for the program under the law. Even in states that did not expand, Medicaid enrollment has jumped due to publicity about the Affordable Care Act and its new online marketplace.

The big question is whether doctors who saw more Medicaid patients when they were paid more will limit their number since the program expired.

Tom Banning, CEO of the Texas Academy of Family Physicians, said he believes that is happening. “Unfortunately, we are hearing from doctors that have had stop seeing Medicaid patients because they can’t take the financial hit.”

Douglas Curran, a family doctor in  Athens, Texas, is one of those cutting back.  He said the Medicaid pay raise had helped his 14-physician group more than double the number of new Medicaid patients it saw in the past two years. “It allowed us to see these patients in the office rather than the emergency room,” Curran said.

Before the pay raise, the rural practice had strict limits on Medicaid appointments because of the low fees.

But despite gaining several thousand new Medicaid patients, Curran said the pay cut means the group will restrict Medicaid appointments once again. “We are going to see as many as we can afford,” he said.

Existing Medicaid patients will face longer waits for appointments and new Medicaid patients are likely to get turned away.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

Deb Hauser was a married mother of a 6-month-old when her husband “went to work one day and didn’t come home.” Two weeks later, she realized she was pregnant.

“I’m working full time. I’ve got this 6-month-old, and all of a sudden I’m pregnant,” she remembers. “I didn’t have any idea what was going to happen. I didn’t know if he was going to come back; if my marriage was going to stick. I didn’t know where I was going to get the money I needed. All I know is I had a responsibility to my 6-month-old.”

Hauser had an abortion, “which was absolutely the right thing to do for me, and for my son,” she says. “I never ever regretted it.” Eventually her husband was diagnosed with bipolar disorder, they were divorced, and she remarried and raised her son, who is now 20. “Abortion has played a really important role in my life,” she said. “It got me stable again.”

Now she wants to help other women tell their abortion stories. It’s part of an effort by her organization, Advocates for Youth, and several others to “de-stigmatize” abortion. As the 42nd anniversary of the Roe v Wade decision that legalized abortion approaches Thursday, abortion rights forces hope this new tack will help them reverse the momentum gained by abortion opponent in recent years. Not only have states passed a growing list of abortion restrictions, but with the U.S. Congress now in GOP hands, federal restrictions are likely to pass as well.

“It’s very clear that pro-life legislators and people running for office are on the offense now,” said Marjorie Dannenfelser, president of the anti-abortion advocacy group, the Susan B. Anthony List. “It’s also very clear that our opponents are on the defense.”

Planned Parenthood President Cecile Richards, who appeared at the National Press Club in Washington a day before Dannenfelser, conceded as much.

“The new Congress is introducing anti-women’s health bills at the rate of one per day,” she said. The House is expected to vote on a bill to ban abortions after 20 weeks of pregnancy on the day of the Roe v Wade anniversary.

But in addition to fighting legislative efforts, abortion rights backers hope to change the public view of abortion, much as gays and lesbians have done of homosexuality in recent years.

Having more women talk about their experiences, they say, will help underscore the statistic that an estimated one in every three American women will have an abortion during their reproductive lifetime.

“Probably everybody knows somebody who’s had an abortion,” said Lindsay Rodriguez of the National Network of Abortion Funds. “They just don’t know they know somebody who’s had an abortion.”

The stigma around abortion “permeates every aspect of our culture,” says Steph Herold of the Sea Change Program, another group working to make it easier to talk not just about abortion but about other “stigmatized reproductive experiences,” including infertility and miscarriage.

Herold says the stigma is everywhere, from media depictions “where a person who’s had an abortion is often stereotyped as selfish or immoral” to hospitals, which may refuse to provide the procedure not because of ideology, “but because they’re afraid of the backlash or anti-abortion protesters.” Herold says stigma even prevents women from talking about abortion with people they’re close to “for fear it might ruin their reputation or their friendships.”

Advocates for Youth has launched the 1 in 3 Campaign, which has so far collected some 700 abortion stories in audio, video, and print versions. Last fall, the project hosted an eight-hour online “speak out,” at which more than 100 women shared their stories. It’s also prompted a book and a play, Out of Silence, debuting this week in Washington D.C., based on some of the stories.

The goal is two-pronged — to give women a safe place to talk about their experiences and to boost support for abortion rights, says Hauser. “We know from the research that the No. 1 predictor of whether or not you say you’re pro-choice and vote pro-choice is if you know someone who’s had an abortion,” she says.

Richards says the movement to de-stigmatize abortion also has a special appeal to younger women. “They are much more open about sex, sexuality, sexual identity, and abortion,” she said.

Planned Parenthood consulted on the production of last year’s indie film “Obvious Child,” in which a young comedian played by Jenny Slate finds herself unexpectedly pregnant after a one-night stand. “It was so refreshing,” Richards said. “Most of the time abortion is talked about [in the media] it’s some gothic story. This was really about a young woman’s life. What happened, what she decided to do with the support of her family, even her boyfriend.”

Advocates of women “coming out” with their abortion stories are quick to admit that they’re following a page from the same-sex marriage playbook.

“More and more people in the U.S. became aware of the people in their lives who they knew who were gay,” said Jessica Arons of the Reproductive Health Technologies Project. “And they started to become more comfortable with it.” Even abortion opponent Marjorie Dannenfelser says the effort is good politics. “In terms of tactics, it’s smart. I have never underestimated their ability to do the smart thing,” she said.

Which is not to say she agrees that speaking out will – or should – eliminate the stigma. “It’s very true that women are afraid to talk about their abortion,” she says. “It’s very true that there is a lot of shame associated with it. The question is what are the root causes of those things? If this is a child, it’s complicated in a different way.”

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

Are you thinking about tax day yet? Your friendly neighborhood tax preparer is. IRS Commissioner John Koskinen declared this tax season one of the most complicated ever, and tax preparers from coast to coast are trying to get ready for the first year that the Affordable Care Act will show up on your tax form.

Sue Ellen Smith manages an H&R Block office in San Francisco, and she is expecting things to get busy soon.

“This year taxes and health care intersect in a brand new way,” Smith says.

For most people, who get insurance through work, the change will be simple: checking a box on the tax form that says, “yes, I had health insurance all year.”

But it will be much more complex for an estimated 25 million to 30 million people who didn’t have health insurance or who bought subsidized coverage through the exchanges. To get ready, Smith and her team have been training for months, running through a range of hypothetical scenarios. One features “Ray” and “Vicky,” a fictional couple from an H&R Block flyer. Together they earn $65,000 a year, and neither has health insurance.

“The biggest misconception I hear people say is, ‘Oh the penalty’s only $95, that’s easy,’” says Smith, but the Rays and Vickys of the world are in for a surprise that will hit their refund. “In this situation, it’s almost $450.”

That’s because the penalty for being uninsured in 2014 is $95 or 1 percent of income, whichever is greater. Next year, it’s 2 percent. Smith says the smartest move for people to avoid those penalties is to sign up for insurance before Feb. 15, the end of the health law’s open enrollment period.

But a lot of people may not think about this until they file their taxes in April. For them, it will be too late to sign up for health insurance and too late to do anything about next year’s penalty too, says Mark Steber, chief tax officer for Jackson Hewitt Tax Services.

“They’re kind of stuck,” says Steber. “Quite frankly, that’s a very difficult discussion.”
Steber’s team at Jackson Hewitt is also doing role playing with tax advisors to prepare them for delivering bad news – in case taxpayers want to blame the messenger.

Lou Graham works at an H&R Block office in Hartford, Conn., and he is facing the same concerns. He is bracing to tell people who underestimated their 2014 incomes that they received too generous a subsidy and that they’ll soon have to pay the government back.

“I’m going to tell a client, ‘I’m sorry, $300 of your return is not going to be yours.’ Well, that will send them right through the roof,” Graham says.

Like his colleague Smith in California, Graham is afraid some people may be completely unaware of the penalty for not having insurance. That means Graham may have to deliver two pieces of bad news: First, he’ll tell them they owe a penalty for 2014, and then he’ll tell them it’s too late to sign up for 2015.

“So they’re going to get stymied twice,” he says.

But he also hopes to guide people to some good news. A lot of people may not know that they’re able to get an exemption from the law’s mandate to get insurance. And it’s his job to pull it out of them.

“‘I didn’t have insurance for six months, but, you know what? I had got a notice that my electricity was going to be cut off.’ Well, you fall into a hardship case,” Graham says. “Those things need to be explored and not many people want to bring that forward.”

Discussing these issues is important. Tax preparers like Graham can only help if tax filers seek them out. And most people don’t. Not in January, anyway.

“It’s real early. People don’t really start thinking about tax work until they get their W-2s in their hands,” he says.

And that presents a real time crunch. Most people won’t get those W-2 wage statements until the end of January. That gives them just two weeks before the Obamacare clock runs out on them on February 15.

This story is part of a partnership that includes WNPR, KQED, NPR and Kaiser Health News.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.