Isn’t caring for your child worth as much as caring for your parents?

I love it when I see Medicaid patients on my schedule for the day. Working at a community health center, our doors are open to all people, regardless of their ability to pay. It’s hard to run a medical office when you get $20 for a visit, which is what our uninsured patients pay. So when a patient has Medicaid we know we’ll get paid a decent reimbursement for that visit.

On average, Medicaid pays 34% less for a primary care visit than Medicare, which itself pays less than private insurance. In contrast to my situation, many doctors won’t take Medicaid because it pays so much less than what they’re getting from their other patients with private insurance. The people covered by Medicaid – poor women, children, the elderly sick and the disabled – need more choices of where they can get their care, not fewer.

Which is why it was great news to hear that because of the Affordable Care Act, in 2013 and 2014 Medicaid rates will increase to be the same as Medicare rates. This should get more doctors to participate in Medicaid which will expand access for this vulnerable population.

Just as important, it corrects an injustice. The message of the current payment structure is that society, by paying less for Medicaid than for Medicare, values the lives of the poor less than the elderly.  It speaks ill of us when we short change vulnerable populations because they can’t afford lobbyists and devalue the providers taking care of them by paying them less for equal work.

For our clinic it will mean that we will be able to expand our services. We will finally be able to buy an audiometer to screen children for hearing problems. We can get more vaccines to vaccinate our diabetics. We can subsidize medication costs for those who can’t afford it. And, we can see even more uninsured patients with the extra money that we get.

The cost of all this is $5.5 billion dollars a year which is just over a 1% increase in the budget for Medicaid. It’s already paid for since it’s a part of the Affordable Care Act but there’s a showdown coming in 2015 when this pay increase is set to expire. Ideally, this pay disparity will be eliminated once and for all but that seems a dim prospect given the way this Congress operates.   So when the time comes to fight, ask yourself this: Isn’t caring for your child worth at least as much as caring for your parents?

Nilesh Kalyanaraman is a physician who blogs at Progress Notes.

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  • Theresa Willett

    Well said! The lobbyists and politicians so rarely do anything beneficial for healthcare as a whole, we need to keep ourselves informed and ready to fight for fairness!

  • RayPrudencio

    Very good article.  Thank you.  I would like to add that Medicaid covers all ages in a variety of ways depending on the State one lives.  In Florida there are many including elderly people insured by Medicaid.  And, because of the reimbursement many health care providers do not accept these patients.  Until a health care payment system is created to fairly and accurately reimburse health care providers based on the medical need, there will always be those that can afford care and those that cannot.  I agree that the Affordable Care Act is a positive step in the short term.  We can only hope that a long term care solution will be thought of and implemented.  One that allows physicians to practice medicine without first having to consider their bottom line.     

  • Molly Ciliberti

    We need Medicare for all. Why shouldn’t all of the people (citizens) of the United States get the same health care as their elected officials (Congress and Senate) since after all they work for us?!

  • Scholla

    ” It’s already paid for since it’s a part of the Affordable Care Act”  Really?  Don’t you really mean it’s already borrowed from our children’s future?

  • Brenda Adler

    Doesn’t anyone see the inherent flaw in this logic?
    Medicaid rates go up, which allows doctors to see more/provide more services for uninsured people.  So you get more per medicaid patient instead of medicaid covering more people – how does that make any sense to anyone?!

    It’s even worse if you look at private insurance.  I mostly know dentists, but I know that most dentists will cut 30-50% off their bill automatically if you don’t have insurance.  More if your poor.  But if dental insurance cost half as much I could probably afford it!  This. is. ludicrous!  

    Overcharging for some people to pay for people who can’t pay is no way to run a health care system.  Granted every business eats some amount of loss, and the loss is built into the price of everything you buy, but your grocery store doesn’t charge twice as much for bread so they can give a third of their stock away on purpose.

    • Alice Robertson

       You are absolutely right.  The author needs to reword a few things or write more logically.  If they love to see the patients what does it matter if the rates go up, or down, or sideways:) Do the CBO figures agree with the author and which set?  We simply can’t afford the ACA no matter how lofty a goal it is.   The anticipation of the ACA raised insurance rates, it is projected a huge proportion of employers will pay the fines and dump employees off their insurance coverage.  Now how does that help people get care?  Isn’t the government already picking up over half the cost of healthcare?  And what is the true cost of that in terms of monetary sacrifices of doctors and others….and quality care?

      • Helen H

        ” what does it matter if the rates go up, or down, or sideways:) It matters more than you have bothered to think about. These doctors have families and bills to pay. No matter how much they love their patients, lets be real here. It is a business like anything else. You do a job you expect to be paid a decent salary. And 20 dollars won’t get it. That means you expect them to work for nothing? It is a job, you do a job you want to be paid. Why does  what they do for a living, be different from what others do to pay the bills. You expect raises on your jo, why shouldn’t they? Folks it is a job, and no matter if they would do it for free if they could afford to, the bottom line is they have a right to expect a decent salary for what they do.

  • crichardsoncae

    Several good points! Access to good care should not be age dependent, and separate money pots add unnecessarily to both the bureacracy and its costs.

    While some will say grey power votes and children don’t, a fact to add here is that workers prepay their Medicare benefits for decades, while Medicaid is covered by general tax dollars.

  • John Ballard

    Thanks you for this courageous post. The moment I read the headline I guessed what it would be about. And as I read I already knew what the comments thread would look like. Sure enough it turns out to be a predictable mixture of cheers from one side countered by hisses and boos from the other. I doubt anything I say here will change many minds. Thanks to the extreme arguments of an election year and an outright assault on ACA many of the stone throwers were picking up rocks the moment they read your first paragraph. 

    In case readers more open to new information are interested, here is a link from a very long and heated discussion about the same subject. Maggie Mahar is a health policy expert who has been following the health care reform debate since before it started and her observations are more balanced and better informed than most. 

    You didn’t mention SCHIP, the federal program for children from families who cannot afford retail insurance but are not poor enough to qualify for Medicaid  Here in Georgia it is called Peach-Care (235 percent of the Federal Poverty Guidelines as of February 1, 2012) and at least one of my grandchildren was a beneficiary during the interval when his parents were pouring all their resources into establishing a new business. 

    PPACA is to public health programs what body casts and several years of rehabilitation would be to victims of a car crash.  I am hopeful that the “patients” (i.e. Medicare, Medicaid, SCHIP. and the various state Exchanges) can recover at least well enough to be ambulatory, even if they have to be dependent on the legislative equivalent of crutches, braces and prosthetic devices.  Unfortunately a large and growing number of opponents seem ready to euthanize any and all public health programs as though they were horses with broken legs.

  • Suki Hoover

    Why can’t we just get rid of the darn lobbyists and run this country in a fair manner? 

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