mead cohen berger shevtsova garfinkle michta grygiel blankenhorn
medicaid madness
Expanding Medicaid In Name Only

Many doctors listed as Medicaid providers may not actually be accessible to patients. The NYT reports on a new survey released by the inspector general of the Department of Health and Human Services. Investigators called “1,800 providers listed by more than 200 health plans under contract with Medicaid in 32 states” to find out how many of these providers would see Medicaid patients. One-third no longer practiced at the address provided—they had moved or retired or were otherwise not there—with another 16 percent either not part of the Medicaid plan in question or not accepting new patients. And even when the providers were taking patients, the wait times to receive care cause their own problems:

“When providers listed as participating in a plan cannot offer appointments, it may create a significant obstacle for an enrollee seeking care,” [inspector general] Mr. Levinson said. “Moreover, it raises questions about the adequacy of provider networks. It suggests that the actual size of provider networks may be considerably smaller than what is presented by Medicaid managed-care plans.” […]

The delays can have significant implications for patients.

“For example,” the report said, “a number of obstetricians had wait times of more than one month, and one had wait times of more than two months for an enrollee who was eight weeks pregnant. Such lengthy wait times could result in a pregnant enrollee receiving no prenatal care in the first trimester of pregnancy.”

Primary care providers, such as family doctors, internists and gynecologists, were less likely to offer appointments than specialists, the report said. But specialists tended to have longer wait times, with a median wait of 20 days, compared with 10 days for a primary care provider.

Supporters of the ACA have been quick to claim the law is working because it has lowered the uninsured rate, in part through the Medicaid expansion. But that expansion may create an increasingly large class of people who are “insured” but cannot get access in a timely fashion—or at all—to a doctor. In light of that, simply citing top-line statistics about the uninsured rate is not a very convincing way to prove a program is working.

Features Icon
show comments
  • Boritz

    “One-third no longer practiced at the address provided—they had moved or retired or were otherwise not there—with another 16 percent either not part of the Medicaid plan in question or not accepting new patients.”

    Here is another category: Not accepting new patients age 60 and over. The poor receptionist has to ask this question. The poor patient has to answer it and accept rejection if they are too old to be a patient of that doctor.

  • Fred Chittenden

    Go figure why doctors wouldn’t want to see Medicaid patients. In WA state, a dentist taking an xray (normal cost $20 to $40) may only get paid $1.38. That’s not enough to cover the cost of the staff to make the appointment, let alone the staff to set up the room, nor take the xray, nor the doctor to view the xray, nor the equipment and supply costs involved, nor the cost or break the room down for the next patient.

    Reality check — Clinics and staff seeing Medicaid patients are frequently getting paid less than minimum wage, FAR LESS THAN PREVAILING WAGES, for caring for Medicaid patients.

    Meanwhile, teachers get full pay for seeing kids on Medicaid, as do burrOcrats managing Medicaid at various levels, as do insurers managing Medicaid payments, as do programmers for Obamacare, as do TVs get paid top dollar for Obamacare ads, etc, etc. Medicaid is not about care, it’s about politics and publicity — most anything but care…

    • FriendlyGoat

      You certainly have the opportunity to get your new GOP Congress to fund Medicaid at higher levels to fix the problem you describe.

      • Fred Chittenden

        Not really. With Medicaid reimbursements as low as 5% of normal fees, there’s no money left to fund the OCare Medicaid expansion without massive tax increases, or cutting entitlement eligibility.

        There is a common sense solution — which makes it unlikely for today’s politicians to adopt.

        If one really wants to ‘fix’ healthcare, it’s simple — allow providers to deduct the unreimbursed cost of charity health care from their income. Over night, clinics everywhere (many of whom currently see few, if any medicaid and/or medicare patients) will develop their own sliding scale plans for charity care, according to their own community needs. This community based (not centrally based) system will be stable thru all sorts of economic ups and downs, and political pandering.

        Since clinics would only gets a deduction against REAL INCOME, there would be a natural check and balance against fraud.

        The only folks really left out of the mix are politicians and burrOcrats, who could continue to try to run their Medicaid and Medicare programs. However, it’s likely the healthcare marketplace, freed from the crony controls of big insurance, burrOcrats and politicians, would choose (as in PRO-CHOICE) the health care that works best for them. Which is why such a common sense ubiquitous solution is unlikely to happen. Doctors and nurses, not politicians would get their due credit for providing charity care — not politicians. This isn’t a solution that contemporary LOSERship politicians of either party are compatible with.

        • FriendlyGoat

          Not a “nice try” at misappropriating “pro-choice”. No one is really interested in “choosing” between this bad insurance plan or that bad insurance plan. We are interested in insurance plans properly defined from a consumer’s standpoint and no one but government does that. Same with cars. Certain features are required by all of us acting in concert. (Why pay for turn signals? I don’t need them, after all. Those OTHER DRIVERS are making me pay for things I don’t need!)

          As for doctors charging some people $300 per fifteen-minute block to see them, then seeing some others for free AND deducting $300 for each of those fifteen-minute “charity” blocks from their income tax, I hope you see the problems with that. My side sees them.

          As for Medicaid money from Congress, there is as much as they declare there is. Wasn’t it your guy, Cheney, who noted that Reagan proved deficits don’t matter? Your fellows are not hamstrung on spending. If they were, there would never have been a tax cut in the last 30 years.

          • Fred Chittenden

            The status quo won’t have the Medicaid pt’s seeing anyone because no one will see them when it costs clinics more to treat Medicaid patients than they get paid.

            FYI, the typical clinic/doctor clinic cost may be around $1200 per hour — that’s the cost of running a clinic, big school debts, heavy progressive taxation, etc, etc. So one should expect a 15 minute apt with a doctor is going to cost about $300. Not that the doctor sees a lot of that. There’s lots of support staff involved in tx and getting paid for it.

          • FriendlyGoat

            As I pointed out to begin with, Republicans now have their chance to step up and fix Medicaid reimbursement to realistic levels. But———somehow——-they’ll probably argue, as you are, that allowing medical corporations to monkey with their income tax would be a better idea. That way they could “pay” the providers from public funds without violating their “principles”——most likely by raiding the treasury for twice what Medicaid should cost, and without necessarily assuring a Medicaid patient the availability of anything whatsoever.

© The American Interest LLC 2005-2016 About Us Masthead Submissions Advertise Customer Service