How Medicaid’s bait and switch fooled doctors


Medicaid expansion “is one of the biggest milestones in health care reform,” according to the Obamacare Facts website. The goal was to provide insurance coverage to low-income Americans, specifically the uninsured. The major problem with Medicaid is low reimbursement. “Due to low payouts, many doctors don’t take Medicaid, and the quality of care tends to be poor,” admits the website. The solution was to raise the amount doctors get paid under Medicaid to the same level as Medicare. Obamacare did just that.

That’s the bait.

Unfortunately, this was a temporary fix, lasting only two years. As doctors rang in the New Year, they saw a 43 percent cut in Medicaid reimbursement.

That’s the switch.

This shouldn’t be breaking news. It was in the Affordable Care Act from the beginning. Then again, we were warned by then Speaker Nancy Pelosi, “We have to pass the bill so you can find out what is in it.” Yet to the journalistic sleuths at the New York Times and Washington Post, this is a surprise, described as “a new threat.” That’s like saying Iran and North Korea are new threats. In the almost five years since passage, shouldn’t reporters in major news organizations have actually read the bill?

The temporary Medicaid payment increase was a classic bait-and-switch move, selling an apparent bargain followed by large price increase. Subprime mortgages are a classic example of bait and switch. Entice homebuyers with attractive interest rates that they can’t afford when the rates jump. The New York Times has been all over this topic, but they seemed to have missed the Medicaid scam until now. Another example is the free trial year of satellite radio and navigation in your new car. After a year, if you don’t want to give up the service you have come to like and depend on, the free trial now costs $15 a month.

The Medicaid bait is working. Sixty-eight million Americans are enrolled in Medicaid, over 20 percent of the population. Now in the system, what will happen to patients if their doctors are suddenly paid 43 percent less? The Urban Institute predicts; “Significant drops in primary care reimbursement may lead physicians to see fewer Medicaid patients, potentially leading these patients to have difficulty finding a physician or getting an appointment.” What a surprise.

Primary care practices pay overhead of 60 percent, according to MGMA — a $100 payment minus $60 in practice overhead leaves the practice with $40 in profit. Now cut that payment by 43 percent beginning Jan. 1. The $100 payment is now $57. The overhead cost hasn’t changed, and revenue becomes negative $3. A real sustainable business model.

Suppose restaurants were told that they couldn’t charge more than $10 for a meal. Great for McDonald’s and Taco Bell, but not for most restaurants. They either go out of business or else start serving fast-food fare. What will physicians do?

The simplest solution is for physicians to opt out of Medicaid. Or at the least, stop accepting new Medicaid patients. Fewer than half of physicians are willing to accept new Medicaid patients, according to a recent physician survey. The University of Colorado Hospital, a safety net hospital for the state, closed its urology clinic to Medicaid and its internal medicine clinic to Medicare. Even the world famous Mayo Clinic is no longer seeing Medicare patients at their primary care clinic in Arizona. Yes, the same Mayo Clinic that was praised by President Obama as a model system. If these hospitals and clinics are opting out of Medicare, what hope is there for Medicaid, which only pays about 60 percent of what Medicare pays?

What to do? How about a single-payer national health care system to handle this insurance mess? That was tried in Vermont. Their socialist U.S. senator, Bernie Sanders, said, “The quickest route toward a national health care program will be when individual states go forward and demonstrate that universal and non-profit health care works, and that it is the cost-effective and moral thing to do.” How did that experiment work out? Not so well. Single-payer struck out in Vermont.

Single-payer is not doing too well in the U.K., either. The NHS, another model for Obamacare, is a “system creaking at seams amid rising population.” A recent report reveals, “People are now routinely waiting more than 12 hours on trolleys even after doctors have decided they need a hospital bed.” At some clinics, “GPs are being forced to offer patients quickfire two-minute consultations.” Cut Medicaid by 43 percent and expect much the same here.

Again, this should come as no surprise. It was in the Affordable Care Act from the beginning. Where was the analysis and debate five years ago? Even the author of the bill, Sen. Max Baucus, admits he never read it. What about our intrepid journalists? CNN is far more interested in the activities of Sarah Palin’s children and can’t even get that story right.

Instead we are left with a mess, confirming Abraham Lincoln’s admonition, “You can fool all the people some of the time, and some of the people all the time, but you cannot fool all the people all the time.” The Obamacare Medicaid bait and switch sure fooled many.

Brian C. Joondeph is an ophthalmologist and can be reached on Twitter @retinaldoctor. This article originally appeared in WND.


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