Sunday, December 28, 2014

Medicaid: Whether Thou Goeth?

Whether thou goeth, I will go, and where thou lodgest, I will lodge, thou people shall be my people, and thou God my God.

Ruth 1:6

Where goeth Medicaid? That biblical verse sprang to mind when I read , “As Medicaid Rolls Swell, Cuts in Payments to Doctors Threaten Access to Care,” by Robert Pear, New York Times, December 28, 2014.

There’s something biblical about Medicaid, even in this secular world. Government, in the minds of some, is God, and he will protect his flock through Medicaid.

And he may be in the process of doing so. Medicaid enrollment exploded from October 2013 to October 2014 by 9.7 million to reach a total of 68.5 million. That’s a 17% surge. It doesn’t take a social scientist to realize that at that exponential rate, Medicaid will inherit the Earth and eat the national budget in just a few years. Medicaid already covers one of five Americans. It’s one down and four to go.

But there’s are three catches. A Republican Congress, a conservative public, both concerned about the national debt and the state of the economy; and shrinking numbers of doctors, reluctant to see and treat Medicaid patients at government rates.

ObamaCare provided an increase of Medicaid rates in 2013 and 2014, but the increase expired this week, and may not be renewed. Cuts will average 43% across the nation for primary care physicians, and by 50% or more in large states such as California, Florida, New York, and Pennsylvania.

George J. Petrucio, a family physician in Turnerville, N.J, says the cuts are a “bait and switch’ tactic. “Once the government attempted to entice physicians into Medicaid with higher rates, then lowers reimbursement once the doctors are involved.”

You can’t just abandon a patient once you have them on board. So you bite the bullet, extend waiting times to see you, and put Medicaid patients at the back of the line.

What else are doctors to do? A survey by the Ohio State Medical Association indicates that Ohio doctors will accept fewer Medicaid patients. You have no legal recourse. The Supreme Court has ruled doctors cannot sue the government to equalize Medicaid and Medicaid rates. Other options include going out of business, going to work for the hospital, hiring more mid-level providers, retiring early, resigning themselves to lower incomes and to accepting government cuts as inevitable, or entering direct pay practices outside the realm and reach of Medicaid.

Under federal law, Medicaid rates must be “sufficient to enlist enough providers” so that Medicaid beneficiaries have at least as much access to care as the general population in their geographic area. To many doctors, this is just meaningless government rhetoric by the elite chattering classes.

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