Washington – Primary care doctors caring for low-income patients will face steep fee cuts next year as a temporary program in President Barack Obama’s health care law expires. That could squeeze access just when millions of new patients are gaining Medicaid coverage.
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A study Wednesday from the nonpartisan Urban Institute estimated fee reductions will average about 40 percent nationwide. But they could reach 50 percent or more for primary care doctors in California, New York, New Jersey, and Illinois — big states that have all expanded Medicaid under the health law.
Meager pay for doctors has been a persistent problem for Medicaid, the safety-net health insurance program. Low-income people unable to find a family doctor instead flock to hospital emergency rooms, where treatment is more expensive and not usually focused on prevention.
To improve access for the poor, the health law increased Medicaid fees for frontline primary care doctors for two years, 2013 and 2014, with Washington paying the full cost. The goal was to bring rates up to what Medicare pays for similar services. But that boost expires Jan. 1, and efforts to secure even a temporary extension from Congress appear thwarted by the politically toxic debate over “Obamacare.”
Doctors probably won’t dump their current Medicaid patients, but they’ll take a hard look at accepting new ones, said Dr. Robert Wergin, a practitioner in rural Milford, Neb., and president of the American Academy of Family Physicians.
“You are going to be paid less, so you are going to have to look at your practice and find ways to eke it out,” Wergin said.
Medicaid covers more than 60 million people, making the federal-state program even larger than Medicare. The health care law has added about 9 million people to the Medicaid rolls, as 27 states have taken advantage of an option that extends coverage to many low-income adults.
Health and Human Services Secretary Sylvia M. Burwell says expanding Medicaid in the remaining 23 states is one of her top priorities. But the fee cut could make that an even harder sell, since it may reinforce a perception that the federal government creates expensive new benefits only to pass the bill to states. In Pennsylvania, where the Medicaid expansion will take effect Jan. 1, doctors are facing a 52 percent fee reduction, according to the Urban Institute study.
The fee boost has cost federal taxpayers at least $5.6 billion so far, but Stephen Zuckerman, one of the study’s authors, said it’s not clear whether access actually improved.
Many doctors did not begin to see the higher payments until the second half of 2013 because of rollout problems. And about three-fourths of Medicaid beneficiaries are in managed-care plans, which may already pay doctors more for routine care and prevention.
Still, Zuckerman said the fee increase was also passed through to doctors seeing patients through managed-care plans, and now they will feel the cuts. “The magnitude of the reduction will be somewhat smaller … but there is no way to believe there won’t be a decrease,” he said.
Despite such questions, some states have recognized the importance of the fee increase. Fifteen are planning to use their own money to continue paying higher Medicaid fees through 2015, Zuckerman said. Among them are several Republican-led states that have resisted Obama’s broader Medicaid expansion, including Mississippi and South Carolina.
Another dozen or so states are undecided.
“If you are cutting primary care fees, patients could end up in the emergency room for something that could be dealt with in a doctor’s office,” said Zuckerman. “That is not a good outcome.”
Doctors groups say they will try to revive the Medicaid fee boost next year, when lawmakers must act to prevent a big cut in Medicare physician payments. The health program for seniors has much stronger political support.
Obamacare did one thing it made the health care industry much richer as you can see by the rise in their stocks in the ‘market’ As all of the federal programs do, make lots of money for the rich few
If Medicaid and other health insurers pay doctors less for their work, they will limit how many subscribers to those plans will be accepted. This undermines the mission of Obamacare, which is supposedly to make health care accessible. There is a balance needed between making care accessible and keeping it inexpensive.
I needed to refer someone to a specialist for consultation – second opinion. Aside from providing names and contact info, I was stuck. He does not have the cash to pay for it. No insurance today covers second opinions, even where the primary treatment is clearly ineffective.
I am not one for making physicians rich. But if the realities of the workplace are ignored, America will become a third world country in the medical field. Is that what Obama wants?
The problem is that by the time it was done…it was such a bad bill that UT needs to be repealed, where people have affordable A+ grade health care, Dr are making more money, and the cost comes down
Ya, if they were smart they would have PA’s and NP’s care for medicaid patients.
In what other wealthy, industrialized country are approx. 1 in 6 people poor enough to qualify for poverty-level medical care?
No good and even nor just competent doctor accepts Medicaid patients already and even fewer will if their fee compensation will suffer another 40-50% decrease. And they shouldn’t: nobody should work for loss or just to break even. This of course means that the poor will be either forced into very inferior Cuba like medical care or squeezed out of access to medical care, other than emergency, altogether. These people voted predominantly for Barak. So how is this obamacare working for them?
And will they learn their lesson? I am not optimistic. They are usually not very capable low functioning people and are vulnerable to demagoguery of the “blame the rich” sort. That’s the only reason demagogues like Barak get elected to any office in the first place.