One of the most tragic results of the new health law is that it will make it harder for many of the most vulnerable in our country to get the medical care they need. This is especially true for patients covered by Medicaid, the government program that pays medical bills for the poor.
For many, Medicaid is a paper promise. It covers an almost unlimited list of medical services, but in reality, Medicaid patients find it hard to find a private doctor who can afford to provide actual medical care. That’s because Medicaid pays doctors and hospitals only about half as much as private payers do — far below their costs of providing the care.
The problem is particularly acute with specialists. One Florida doctor reported that, after a long battle with the state over payment for treating a patient with complex lung disease, he received a check from Medicaid for one penny.
About 16 million people — half of the 32 million who are expected to get health coverage under the new health law — will be enrolled in Medicaid in January of 2014, with almost no changes to improve or modernize the cumbersome, complex, and wasteful program.
This large Medicaid expansion could have catastrophic effects on those who provide society’s health care safety net.
First, there simply aren’t enough doctors to handle this influx of new patients. Given Medicaid’s abysmally-low payment rates, private doctors won’t be able to afford to take much more of the exploding caseload. Nearly half of all doctors in private practice today say they cannot afford to take any new Medicaid patients.
The physician-shortage will be exacerbated by the fact that up to 45 percent of physicians say they are seriously considering leaving practice altogether once the health law takes effect because they fear government controlling their medical decisions.
The poorest and most vulnerable patients on Medicaid today will be competing with millions of new Medicaid patients for appointments with a limited number of physicians. Those who have the greatest need and nowhere else to go are likely to have the hardest time getting care.
Longer waiting lines and an increased reliance on emergency room care are inevitable.
Recipients of Medicaid (and the Children’s Health Insurance Program, which often pays doctors at Medicaid rates) use emergency rooms far more often than people with private insurance. They know that if they wait long enough they eventually will be seen. And they are more likely to visit emergency rooms numerous times in a year, generally because they don’t have anywhere else to go for care.
Catholic hospitals, which treat one out of every six hospital patients in America, are most often the safety-net hospitals in communities. They provide care to the poorest and most vulnerable in our society and, as a result, they are often stretched to the limit financially. Adding millions more people to Medicaid will put crushing new demands on these hospitals.
But the hospitals are being squeezed by the law in another crucial way. To help pay for the expanded coverage, the health law cuts existing Medicaid payments to hospitals that provide care to a “disproportionate-share” of uninsured patients.
Safety-net hospitals are very concerned they will lose more from these cuts in existing payments than they will gain in revenue from newly-insured patients.
In addition, at least 23 million people will remain uninsured after the law is fully in effect and will continue to need care, often without an ability to pay.
Clearly, the huge expansion of Medicaid will make it even harder for the patients already on Medicaid to get the health care they need and will be little more than the same paper promise to the 16 million people who will be added to the program.
Given time, resources, and greater flexibility, hospitals could work with other medical facilities to create a system of care for the uninsured. But with millions more people added to an unreformed Medicaid program in one day, safety net providers will be overwhelmed.
There is a better way: Allow people on Medicaid the option of private insurance so they can get coverage through private competing plans. These plans could provide access to physicians, coordinate care for patients with multiple health problems, and allow patients to be seen in doctors’ offices rather than in expensive hospital emergency rooms.
Patients would have the dignity of private coverage, and safety-net hospitals will be able to keep their doors open so they can continue their mission of caring for the poorest and neediest in our society. There is a better way.
Posted on the Catholic Advocate, March 20, 2012.