If you thought it was getting increasingly difficult for Medicare and Medicaid patients to see a doctor, you’re right—and that problem may get even worse in 2015.
Doctors who still accept Medicare patients could see an average reduction of 21.2 percent in Medicare reimbursement rates, according the Department of Health and Human Services. And a new Urban Institute study claims primary care physicians who still take Medicaid patients could see an average reduction of 42.8 percent.
Think those pay cuts just might affect access to medical care?
At issue is what the Affordable Care Act, or Obamacare, did and did not do.
First, what it did do: Obamacare increased Medicaid reimbursement rates for primary care physicians to Medicare levels—but only for two years, 2013 and 2014.
Medicare, which provides health coverage for seniors, pays doctors, on average,about 80 percent of what private health insurance pays. However, Medicaid, which provides health coverage for the poor, pays a much lower rate, about 56 percent.
And yet one of the primary ways Democrats planned to increase the number of insured under Obamacare was by expanding Medicaid to millions more. In order to stifle opposition from physicians and states to their Medicaid expansion, Democrats drafting Obamacare included a two-year bribe to buy support. That increase just expired and lower Medicaid reimbursement rates are back.
The Urban Institute just released a report estimating the decrease by state. Across all states, Urban estimates a 42.8 percent reduction in primary care fees for eligible physicians in 2015.
But Urban breaks the analysis down by various groups. It estimates that doctors in the 27 states that expanded Medicaid under Obamacare will see a 46.2 percent reduction, while primary care doctors in states that did not expand Medicaid will face a 36.8 percent reduction.
So maybe there were good reasons for not expanding Medicaid.
For several years, doctors have increasingly refused to take new, and in some cases any, Medicaid patients. The Physicians Foundation’s “2014 Survey of America’s Physicians” reports that 38 percent of physicians either do not see Medicaid patients or limit the number they see. Generally speaking, primary care doctors have been more willing than specialists to continue taking Medicaid patients.
In the recent budget negotiations, President Obama proposed, and several Democrats supported, a one-year extension of the Medicaid bribe, but that provision was not part of the final agreement.
If Republicans (appropriately) refuse to re-instate the “temporary” increase, we will likely see doctors abandoning Medicaid even faster than they have been, and Obama’s promise to improve access to health care may turn out to be as good as his promise that you could keep your doctor.
Second, what Obamacare didn’t do: It did not resolve the “doc fix” problem. In 1997 Congress passed legislation that said if its efforts to slow Medicare’s growth rate to match GDP were unsuccessful—referred to as the “sustainable growth rate,” or SGR—Medicare would lower what it paid doctors to achieve the goal.
Congressional efforts to stem Medicare’s growth rate failed for more than a decade; it started slowing some years ago, mostly because of the recession.
But Congress repeatedly postponed those required cuts by passing legislation that temporarily kept reimbursement rates roughly unchanged. It has until April 1 to come up with a solution or doctors treating Medicare patients will see an average 21.2 percent reimbursement cut.
Democrats initially wanted to include a permanent doc fix in Obamacare, but doing so raised the official cost of the legislation well above Obama’s stated—though fraudulent—target of $1 trillion. And so that provision was dropped. The Congressional Budget Office (CBO)now estimates that keeping the current rates the same for 10 years will cost $119 billion.
Now that Republicans are in charge, they will probably (and reasonably) want to offset the additional cost of the doc fix with other budget cuts, known as “pay fors.” Or Republicans might attach the doc fix, which Obama and Democrats want, to legislation they don’t want—like approving the Keystone XL pipeline, limiting some of the Environmental Protection Agency’s overreaches, or rolling back part of Obama’s amnesty executive order.
The point is that while there will likely be bipartisan support for some type of doc fix, it might get bogged down in legislative maneuvers.
So doctors could be in for a bruising financial year, losing 21 percent of their Medicare reimbursements and 43 percent of Medicaid. And that means patients, both seniors and the poor, may not be able to find a doctor who will take them.
There is nothing new in these types of access problems; countries with socialized medicine experience them frequently. And the U.S. will see even more of them as we move closer to the health care system Obama has acknowledged he really wants—a government-run, single-payer system.