Doctors had shown less and less interest in Medicare participation as the program's reimbursement has not kept up with the cost of providing care and regulations have increased. The Texas Medical Association found in a 2023 survey that 35% of its members said they would not accept new Medicare patients, up from 22% in 2000.Clinicians, particularly in wealthy metropolitan areas, feel they can opt out of the program because they can fill their practice with patients who have commercial insurance or are willing to pay out-of-pocket for care.The CMS saw a sharp decrease in the number of providers opting out of Medicare in 2023. after several years where thousands indicated that they did not want to participate in the program. Some groups like the American Medical Association have noted that by and large, doctors are staying in Medicare and accepting patients. The CMS estimates that just over 1.3 million providers now bill Medicare.The doctoru2019s Iu2019ve worked with, all specialistu2019s did not want to enter various Medicare select programs, u201ccalling them just another Medicaidu201d. Reimbursements even lower then traditional Medicare, and way too many restrictions, rules and oversight, making it impossible to practice medicine as they feel it should be.