Medicaid’s broken ‘doctor fix’

When the Affordable Care Act, or ACA, was signed into law, three out of 10 physicians were not accepting new Medicaid patients. So to entice more physicians to participate in the Medicaid program, the federal government began temporarily paying higher reimbursements for some of primary care physicians’ routine services. But temporarily boosting a narrow subset...

When the Affordable Care Act, or ACA, was signed into law, three out of 10 physicians were not accepting new Medicaid patients. So to entice more physicians to participate in the Medicaid program, the federal government began temporarily paying higher reimbursements for some of primary care physicians’ routine services.

But temporarily boosting a narrow subset of physicians’ reimbursements in hopes of greater participation in the Medicaid program is nothing but a quick fix. It’s a gimmick that does nothing to address the underlying problems of accessing care in a broken system.

The payment boost applies only to a select group of primary care and family medicine physicians (and excludes OB-GYNs, for example), and is only available for 2013 and 2014. Furthermore, preliminary survey data from the nation’s largest 15 cities show that this approach has not improved overall access to primary care.

According to a recent physician survey, Medicaid acceptance rates for primary care physicians increased in only six of 15 cities between 2009 and 2013 – the first year of the temporary reimbursement increases.

Furthermore, access to care actually worsened. Among all physician specialties, fewer than 46 percent were accepting Medicaid patients in these 15 cities in 2013 compared to 55 percent in 2009.

Setting aside the fact that they do little to fix a broken system, these increases come with a serious risk of states having the rug pulled out from under them.

Unless the states are willing to foot the bill for their share of the $11 billion tab to keep the higher reimbursement levels or the federal government making the increased rate permanent, Medicaid reimbursements will automatically revert back to the pre-ACA levels on Dec. 31, 2014. If Illinois wants to boost the reimbursements for this particular group of physicians, the state could be facing more than $200 million annually in additional costs.

Medicaid patients in Illinois not only face longer wait times for care than the privately insured, but they also are unable to access specialists two-thirds of the time. The ACA expansions essentially embrace an approach that increases the program’s enrollment numbers without thoughtful and equal regard for ensuring timely access to that care.

That is why these “doctor fixes” fail to provide true access to those already in the program. It is yet another example of why Medicaid’s command-and-control approach to health care routinely fails to deliver quality care to patients and is fiscally unsustainable.

The only consistent winners of this approach, up to now, have been the politicians who enthusiastically take political credit for passing out Medicaid cards, but do so without protecting taxpayers or providing patients true access to care or control over health care decisions.

A Medicaid card is not the same thing as accessible health care. And expanding its ranks without addressing that simple fact is harmful to patients and taxpayers alike.