January 13, 2010

Can We Agree on SOMETHING?: Increasing Medicaid Reimbursements

I read an article today on the The New Republic that made a great case for one issue that is being toyed with in the health reform debate on which we could potentially all agree: increasing the amount Medicaid reimburses physicians, specifically primary care physicians. For anyone who isn't quite sure what Medicaid is, it's our federal and state program that covers the medical expenses of people whose incomes are near or at the poverty line. Except that "federal and state program" implies that it's pretty much the same across the country (it's not), and "near or at the poverty line" skirts over the huge discrepancies with what qualifies in some states versus others - and don't even get me started on what the poverty line actually means and how it's a horrible measure of anything.

Back to Health Care Reform: Currently, Medicaid reimbursements to physicians (ie how much physicians get paid by insurance) are much lower than the reimbursements physicians receive from private insurance companies. This divergence is most notable in how Medicaid pays primary care physicians. The result of all this is that many physicians have to limit the number of patients who have Medicaid or stop seeing patients with Medicaid altogether (see a Washington Post article on the Mayo Clinic discontinuing all Medicaid Pateints). With the economic recession and health care costs climbing, decreasing the number of patients with medicaid is becoming a way for hospitals and physicians everywhere to reign in costs. From the Post article about the Mayo Clinic: "These decisions aren't based on timing with what's going on with the legislation," said Mayo spokeswoman Shelly Plutowski. "It simply is the reality of the health-care business, and how are we going to be able to continue our mission when these payments are so far below what it costs to provide the care."

This should be a wake-up call to anyone who is worried about the "rationing" of health care with any movement towards a system that covers more people that we already do ration health care. The only difference is that right now it is rationed away from those who cannot afford to pay for it (and who, coincidentally, have the highest likeliness of needing health care).

I'm hopeful that this could be one change that we could all get behind.

**Addition on 1/18/10: Letters to the New York Times about their article on increasing Medicaid reimbursements. It includes some from internal medicine physicians, directors of Medicaid offices, etc. Check it out here.

"It's not about rationing care-that's always the bogeyman people use to block reform. The real problem is unnecessary and unwanted care."
-Dr. Fisher, Professor, Dartmouth Medical School

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