Medicaid Deserves More Respect

If you're on Medicaid and your child needs a pediatric specialist, good luck finding one. You are up to five times less likely to get an appointment than someone with private insurance.

That is the finding of a study just published in the New England Journal of Medicine . (See last Thursday's Inquirer for a full description.)

This is not news to most Medicaid recipients. It is well known that many physicians, particularly specialists, avoid taking public insurance.

The attitude of physicians is understandable. Medicaid reimbursement tends to be extremely low, and payments are often delayed for months. For many, the economics of taking Medicaid just don't work.

State governments, which run Medicaid, can't really be blamed, either. The program accounts for over 20% of state budgets on average, even though the federal government picks up at least 50% of the bill. It is single largest expense for many states, and its costs continue to rise relentlessly.

Faced with budget crises, several states want to restrict Medicaid coverage by limiting eligibility. Further cutbacks in reimbursement for providers are also possible, which could make it even more difficult for beneficiaries to find one.

Budget negotiators in Congress may propose new cuts to the federal share of Medicaid. Republicans want to re-engineer it completely. They would eliminate most national standards and turn it into a set of block grants to states, which could then make drastic changes to coverage.

All of this is bad news for health reform. Obamacare relies on Medicaid to cover 16 million more people starting in 2014. That is half the number who will gain new coverage under the law. A shrunken Medicaid program would have difficulty shouldering this new burden.

Medicaid seems like an easy target for budget cutters. It's nice to provide free health insurance for the poor, but generosity often fades when economic times are tight.

But much more is at stake. Medicaid is also a lifeline for many inner city and rural hospitals. Without it, indigent patients would have no coverage at all. Even meager Medicaid payments are better than nothing.

In the long-run, Medicaid may actually save money. Without it, states would need another, and possibly more expensive, way to keep hospitals in poor areas afloat. They would also face a range of consequences from more sickness and disability in their populations.

Medicaid's problems spell trouble for all of us, even if we are not beneficiaries trying to get a doctor's appointment. We owe the program much more than many seem to realize. We should keep that in mind as our representatives consider whether and how to change it.

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