With Washington recently expanding Medicaid coverage, more low-income families across the state have access to health insurance. Unfortunately, having access to insurance coverage doesn’t equal having access to care; many of those newly insured families are finding it difficult to find primary care physicians available to treat them.
This conundrum was made clear when The Vancouver Clinic recently announced it will no longer accept new Medicaid clients and, over the next three years, will reduce the number of Medicaid services it provides to Clark County residents. In three years, Medicaid services, currently representing 25 percent of the clinic’s total business, will be reduced to 10 percent.
A physician’s practice loses money when seeing a Medicaid patient. Medicaid reimbursement rates, currently at 66 percent of Medicare rates, are far below what it actually costs to provide that care and a clear loss to the physician practice. It’s not a complicated math problem to figure out that in order for a practice to remain viable, it often must face the stark option of limiting the amount of subsidized care it provides.
This problem will likely get worse, as fewer and fewer physicians choose to put their practice in financial jeopardy in order to accommodate all patients. A “perfect storm” is brewing that may leave patients and physician practices paddling upstream.
In anticipation of this challenge, the Affordable Care Act temporarily increased Medicaid reimbursement rates to Medicare levels, providing financial incentive for physicians to continue caring for Medicaid patients. However, this funding will end December 31 unless Congress and our state legislators act. If they don’t, we may see a ripple effect throughout the state of practices closing their doors to those we have worked so hard to insure.
Follow through lacking
Our state lawmakers have recognized the importance of providing access to care for our citizens by expanding the number of people who qualify for Medicaid — and we at the Washington State Medical Association applaud that commitment. Unfortunately, our state has failed to follow through on a long-term commitment to ensure that physicians can afford to treat these newly insured patients.
Medicaid currently serves more than 1 million low-income residents in our state — including 472,000 children. Expanded Medicaid coverage generates new demands for access in a system already short of adult primary care providers and some specialists. Adding to the pressure, many of the adults gaining Medicaid are expected to be in fair or poor health, have chronic physical and/or mental health conditions, and arrive with pent-up needs for health care.
Without a commitment by the state to support physicians who take Medicaid patients, the burden is shifted to the physicians’ practices, which must decide whether to subsidize patient care at an economic loss — putting their entire practice at financial risk — or limiting the number of Medicaid patients they treat.
The impact expands to other areas of health care as well, as patients who cannot access a primary care physician often wind up in the ER, increasing wait times and increasing costs and insurance premiums for everyone. The American College of Emergency Physicians just released a poll that shows ER visits are up since the Affordable Care Act began. Without access to quality primary care, preventable emergency room visits increase while health outcomes worsen, costing the state money, productivity and lives.
The state is obligated to make sure that those who qualify for Medicaid receive proper services from an adequate network of physicians. To abandon that obligation would be a breach of the social contract between the state and these beneficiaries.
Funding fair Medicaid reimbursement is a big step toward helping physician practices meet the demands of the patients who were promised coverage by our state while not jeopardizing the financial health of medical practices. It’s up to our state Legislature to follow through on that commitment.
Dr. Dale Reisner is president of the Washington State Medical Association, which represents physicians, residents, medical students and physician assistants throughout Washington. She is a maternal/fetal medicine physician in Seattle.