The Health Care Debate Rages On but No One is Talking About This

Have you noticed that while health care costs are soaring, the time you actually spend with doctors is vanishing? This year I waited for two hours to see a doctor for 90 seconds. Not surprisingly, the diagnosis received and the treatment prescribed were wrong.

It turns out my experience is common for patients on Medicaid, if we can even be seen to begin with. When the Affordable Care Act passed, I jumped at the chance to purchase good insurance through one of the ACA exchanges. Despite having a different plan than people receiving care through Medicaid, I am grouped with them through our indistinguishable ACA plans.

Very recently, a doctor’s assistant explained to me that for Medicaid, reimbursements are ridiculous. I’ve had a devil of a time finding therapists who take our insurance. For a child with special needs, access to care such as physical or speech therapy isn’t something optional. But millions of families just like ours with special needs kids effectively don’t have access to this care because they are on Medicaid. 

Why is access to Medicaid health care so difficult? Well, a big factor is the Medicaid maximum dollar amount on how much care a patient can receive in one day. That number is very low. And the insurance company will only pay a fraction of the cost for some services. Medicaid reimburses in my state, about 50% of what they consider fair and reasonable payment for a service. Ludicrous. Obviously, the AMA is pissed.

The report noted that while Medicaid expansion has increased access to health insurance, those coverage gains have not necessarily increased U.S. residents’ access to health care. The report listed low Medicaid reimbursements for providers as a key obstacle.

The report noted that among state Medicaid plans, half of health care providers listed in the plans’ networks either were not participating in the plan at the location provided or were not accepting new patients who were Medicaid beneficiaries. In addition, the report found that patients faced wait times of at least four weeks at more than 25 percent of participating providers.

I dont want to carry water for the insurance industry. I am not convinced the answer is to give them more money. But the answer is certainly not to pay the doctors poorly because it gives an incentive for doctors to avoid Medicaid patients by refusing to take their insurance.

And this is certainly not an argument against Medicaid in general. But we need to think about our entire health care system and question why those on Medicaid receive substandard health care. 

In the US, tens of millions of these patients are children. Reduced access to care can shorten their lives. And many disabled children are on Medicaid which means care they need can be compromised, causing major difficulties in their lives. Is this really the best we can do?

Well, no. When the ACA was first introduced, the government did give increased payments to doctors for Medicaid primary care services. But that bump in payments ended in 2014. And many states, including mine, elected not to continue paying. Here’s an Urban Institute study on the subject.

Overall, primary care fees in the Medicaid program would fall an average of 42.8 percent in 2015 if no extension of the ACA primary care fee increase policy were granted. The fee reduction would be even larger—47.4 percent on average—in those states that do not plan to extend the fee bump using state funds. To put the magnitude of these fee reductions in some context, consider that the projected Medicare fee reduction under the sustainable growth rate formula was 24 percent in 2014. That cut and every potential fee cut under the formula since 2003 has been delayed by Congress.

Make no mistake: these cuts are too much for the elderly on Medicare but not too much for the country’s children on Medicaid. At least according to Congress who has not acted for Medicaid recipients. Our system is broken.

And again, while I am certainly for access through Medicaid and the Medicaid expansion, let’s be honest with ourselves that Medicaid or Medicare for all may have some unintended consequences. We should pursue universal coverage however we can get it, but the entire health care system is going to need an overhaul when we are done.

As a patient who used to have employer insurance and now uses Medicaid, there is a vast difference in the care I receive from most of my doctors. They are all good. But they can’t afford to waste too much time on me. 

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