Archives for 2014

The Washington Post’s Wonk Blog reported on how people on Medicaid expansion felt about the program earlier this week:

Medicaid enrollees are generally happy to have coverage, though many are encountering roadblocks to receiving the care they want, according to new research that provides one of the earliest insights into people’s experiences under the expanded health insurance program for low-income Americans….

Before obtaining new coverage, most people in the focus groups said they delayed medical care while they had been uninsured, and some in the focus group said they’re facing medical debt for care that they couldn’t delay. Preventive care, in particular, had been a challenge for this group – many said they hadn’t received a checkup in years….

The enrollees’ biggest problem has been finding a primary care doctor, which has been a major concern in the health policy community….Some new enrollees in the focus groups said they had to call at least six practices to find a doctor, some had to choose doctors far from where they live

The biggest problem with the Medicaid network is a pricing problem.  Providers are paid too little compared to their next best set of alternatives.  Therefore, getting providers willing to take on new Medicaid patients is a pain in the ass.  Usually providers who take on Medicaid patients are either part of a major academic medical center group, a charity/provider of last resort center, or fairly young and building out a new practice.  Mid-career providers in the suburbs with an office in a nice building are unlikely to take new Medicaid patients; they may continue to serve patients who they started to see early in their careers or who had changed insurance to Medicaid, but are unlikley to look to fill their roster with new, low paying, Mediaid patients especially when much higher paying Exchange patients are now insured and available.

PPACA temporarily addressed this problem.  For Calendar Year 2013 and 2014, the feds as a 100% pass through to the states raised the Medicaid reimbursement rate for primary care services to be equal to that of Medicare.  This is typically a 40% to 70% raise.  As expected, panels opened up and more providers have been taking on new Medicaid patients.  However, on January 1, 2015, the enhanced payment rates  are set to fall back to standard Medicaid rates.  Two states have base rates above the enhanced rate, and six states are paying for the extra reimbursement with state money. 

There is a proposal to extend the payment enhancement for another two years as well as broaden its applicability to more provider types and services.  This bill would cost $11 billion over two years, and it would be a good idea.  I don’t think it will pass. The Republican Party is more opposed to anything that benefits poor people and potentially Obama than in sending money to very high income individuals.  Spending money would solve a significant chunk of the Medicaid access problem.

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