Surprise: Medicaid Recipients Could See Significant Access Reductions

by William Teach | December 28, 2014 8:26 am

I don’t think anyone saw this one coming down the pike

(NY Times[1]) Just as millions of people are gaining insurance through Medicaid, the program is poised to make deep cuts in payments to many doctors, prompting some physicians and consumer advocates to warn that the reductions could make it more difficult for Medicaid patients to obtain care.

The Affordable Care Act provided a big increase in Medicaid payments for primary care in 2013 and 2014. But the increase expires on Thursday β€” just weeks after the Obama administration told the Supreme Court that doctors and other providers had no legal right to challenge the adequacy of payments they received from Medicaid.

The impact will vary by state, but a study by the Urban Institute, a nonpartisan research organization, estimates that doctors who have been receiving the enhanced payments will see their fees for primary care cut by 43 percent, on average.

Stephen Zuckerman, a health economist at the Urban Institute and co-author of the report, said Medicaid payments for primary care services could drop by 50 percent or more in California, Florida, New York and Pennsylvania, among other states.

The upshot?

Dr. David A. Fleming, the president of the American College of Physicians, which represents specialists in internal medicine, said some patients would have less access to care after the cuts. It would make no sense to reduce Medicaid payments β€œat a time when the population enrolled in Medicaid is surging,” he said.

The rolls surged since the start of Obamacare in 2013. 9.7 million have been added, and more than one-fifth[2] of the U.S. public are covered. More people, same (or slightly lower) number of doctors, hospitals, and medical centers. Significantly reduced payouts. A system that didn’t work well in the first place. And let’s not forget the incentives for poor people on Medicaid to stay poor. A recipe for disaster.

Obamacare isn’t about access: it’s about forcing people to have some type of insurance and controlling costs. If you increase Medicaid rolls, but people can’t get treatment, what’s the point? If more people sign up for regular insurance through the Exchanges, but people can neither afford the deductibles nor find doctors that can see them, what’s the point? How does it help?

Crossed at Pirate’s Cove[3]. Follow me on Twitter @WilliamTeach[4].

  1. NY Times:
  2. more than one-fifth:
  3. Pirate’s Cove:
  4. @WilliamTeach:

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