Medicare Access Already a Problem; Medicaid Bad Sign for Future

It doesn’t take a fortune teller to predict what will likely happen if Medicare physician benefits cuts are not blocked next year:  Medicare beneficiaries will suffer. The Path to Prosperity recommends a 10-year “Doc Fix” in the form of a reserve fund that does not add to the deficit.

Access is already a problem.  A recent survey of doctors reveals nearly a third of primary care physicians restrict the number of Medicare patients in their practice mainly on account of low and unreliable government payment.  The American Academy of Family Physicians reports that more than 12 percent of its doctors simply don’t accept Medicare patients, up from 8 percent in 2008 and 6 percent in 2004. Even the president of the New York Medical Society no longer takes Medicare patients.

And the potential impact on access of much lower reimbursement?  Access for Medicaid beneficiaries is not a good sign.  Years of inadequate payment rates, below the cost of care at times, have contributed to widespread access problems for both primary and specialist care:

• Inadequate payment is the most common reason for providers not to accept Medicaid patients.

• Only 42% of primary care physicians in 2008 were accepting all or most new Medicaid patients compared to 61% for Medicare patients and 84% for those with private insurance. 

• Medicaid enrollees access care through the emergency room at twice the rate of the uninsured and those with private coverage.  “With states squeezing payments to providers…patients are finding it increasingly difficult to locate doctors and dentists who will accept their coverage.  Inevitably, many defer care or wind up in hospital emergency rooms.”

• Acute national shortages of pediatric and adult specialists in Medicaid are “large and growing concerns” according to a recent Kaiser Family Foundation roundtable discussion with government officials and experts.  “Inadequate access to specialist care poses particular risks for many in the Medicaid population.”

• A typical example:  An obstetrician who has seen Medicaid patients for a quarter century is forced to limit the type of Medicaid patients he takes because of low reimbursement: “Pregnant women, yes; other women seeking gynecological care, no."

Just this month the New York Times reported “Children on Medicaid Shown to Wait Longer for Care” and “As Number of Medicaid Patients Goes Up, Their Benefits Are About to Drop” referring to anticipated changes when nearly $90 billion in extra Medicaid money for states in the President’s “stimulus” package runs out tomorrow.

Now consider the CMS Actuary confirms Medicare rates for physician services will drop well below Medicaid’s rates as detailed in the graph below.

So if the Texas Association of Health Plans is correct when it predicts “further Medicaid fee cuts could set off a doctor stampede," what will doctors do if nothing is done to protect Medicare from the fallout of President Obama’s and Democrats’ government takeover of healthcare? 

What comes after stampede?