Just when millions of Americans are enjoying insurance coverage through Medicaid, payment cuts are soon to be enforced as the rate increase offered by the Affordable Care Act expires Jan. 1. Once it does, consumer advocates and physicians warn that it will make it harder for Medicaid patients to get the care they need.
The Affordable Care Act made it attractive for doctors to join the Medicaid program in 2013 and 2014 by increasing payments. This resulted in more doctors offering primary care services, which more patients benefited from. President Barack Obama proposed an extension of one year for higher payments back in March but the proposal languished. Should it have been given ample attention, it will receive just as much opposition from Republicans controlling both houses in Congress.
Because Medicaid programs differ from state to state, reductions in payments will vary and primary care services will see an average of 43 percent in cuts, as per a study by the Urban Institute. Stephen Zuckerman, co-author of the study and a health economist from the Urban Institute, however, added that Pennsylvania, New York, Florida and California may see primary care services payments drop by as much as 50 percent or more.
Dr. David A. Fleming, American College of Physicians president, said it makes no sense to cut Medicaid payments. Less access to care is a big concern but the move is mainly counterproductive at a time when the number of people enrolling in the program is increasing.
Family physician Dr. George J. Petruncio from Turnersville, New Jersey calls the impending payment cuts a "bait and switch," enticing doctors to participate in Medicaid by offering higher rates and then lowering reimbursements when they're already involved.
Since 2013, Medicaid saw the addition of 9.7 million people to the program, bringing total enrolled to 68.5 million. That figure represents over a fifth of the American population, translating to Medicaid contributing the largest coverage gains in 40 years, according to the White House.
Medicaid is bound by federal law to impose rates that will encourage enough doctors to join such that members will have the same access to primary care as the rest of the general population within their area.
The need to attract doctors is what gave birth to the fee increase. Joseph A. Reblando, Medicaid Health Plans of America trade group spokesperson, said the idea was good in concept but it was guided by an outdated system where doctors are paid separate fees for each service they render.
Medicaid and Medicare are commonly confused. Medicaid is aimed at helping low-income individuals while Medicare is mainly geared towards assisting those with certain disabilities and/or aged 65 years old and up.
