Raleigh, N.C. — The national health care reform law, which was designed to provide insurance coverage and access to physicians to more Americans, has no provision to help a group already having difficulty finding doctors to treat them – senior citizens.

According to a report from Cigna Government Services, which processes Medicare claims in North Carolina and 17 other states, more than 80 physicians in North Carolina have opted out of Medicare in the past year. That's in addition to the 100 physicians statewide who stopped seeing Medicare patients in 2008, the report states.

Even more practices have stopped accepting new Medicare patients. Family Medical Associates of Raleigh, for example, decided three years ago to accept Medicare payments only from existing patients.

"The payment from Medicare for our services is less than it costs us to provide those services," said Dr. Conrad Flick, a partner in Family Medical Associates and a board member of the American Academy of Family Physicians.

The gap has grown every year, he said, as salaries and overhead costs have increased while the reimbursement rate under Medicare has remained relatively flat.

The decision to turn away patients on Medicare wasn't an easy one, Flick said, but it was the only option he and his partners had if they wanted to remain in business.

"Our job is to take care of patients, which is what we love, but if we can't run our business, we can't take care of any patients," he said, noting they continue to turn elderly patients away almost daily.

Shirley Roth, a 74-year-old Creedmoor resident, said she spent several months hunting for a new doctor after becoming disenchanted with the staff at her former physician's office.

"They wouldn't take me. They said they were full because I was on Medicare," said Roth, who works as the bookkeeper for her son's Raleigh business. "You get depressed. You wonder, where are you going to go for good care?"

Flick said he's especially worried about rural areas, where physicians are few and far between and tend to have large percentages of Medicare patients. If those practices close or the doctors opt out of the Medicare program, senior citizens in those areas would have to travel long distances to get health care.

A battle brewing in Washington, D.C., could drive even more physicians from the Medicare program or force some practices to close.

A 23 percent cut to reimbursement rates is scheduled to take effect Dec. 1, followed by another 6.5 percent cut in January. The cuts are mandated by a law that links reimbursements to growth in the gross domestic product.

Lower cuts were supposed to take effect in June, but Congress approved a so-called "doc fix" to delay them for six months. Some members of the House and Senate want to increase Medicare payments to keep physicians and hospitals in the system, but a vote isn't likely before the November elections because the move could add $22 billion to the federal deficit.

President Barack Obama signed the "doc fix," which increased reimbursements by 2.2 percent, but his administration recently touted savings in the Medicare system, such as lower reimbursement rates, for putting the system on better financial footing.

"It's a political hot potato," Flick said. "They don't want to be the one who makes the cut or makes the change because it's not very good politically for them in an election year."

Roth, who eventually found a new doctor, said senior citizens need to lobby Congress for Medicare upgrades.

"We need to all get out there and say, 'Hey, we need help. How do we make this work? What are representatives and senators doing to help us?'" she said.