Working for thirty-two cents on the dollar

With Healthcare reform cruising into town January 1st 2014, more and more details of the ACA are surfacing. Many uninsured Americans will qualify for coverage via Medicaid, as a major component of the law is the expansion of the Medicaid program.  Medicaid is STATE RUN health insurance coverage offered to children and families at or below the poverty line.  For 2012, the poverty line was drawn at $11,170.  For a family of four, that line grows to $23,050.

Under the Affordable Care Act, Medicaid coverage is set to expand coverage to over 16 million additional people, including those making upwards of $32,000/year.  The June Supreme Court made it optional for states to expand Medicaid to cover these new enrollees by providing federal funding.  Even with this generous federal funding, several states have decided they cannot afford the expansion, which would cost states at least $118 billion through 2023. While the main question usually is who will pay for this expansion of care, there are many unknowns that remain.

The headlines of the ACA promise healthcare for all.  However, the underlying issue is who will provide this care?  A key cost saving component of Medicaid is that they are able to pay doctors and hospitals less than private insurance.  In fact a lot less.  In Missouri, Medicaid pays thirty-two cents on the dollar.  Want to see a physician that charges $100?  She gets $32 from Medicaid.  Having $5,000 cataract surgery?  Medicaid pays $1,600.  With payment rates that low, it’s no wonder that over 30% of doctors won’t take new Medicaid patients.  With 16 million new Medicaid members on January 2014 and a projected physician shortage of 150,000 in the next 15 years, where will these newly eligible Medicaid patients turn for care?  The question is, where will the providers come from.  If you were asked to go through years of school and 80 hour residency work weeks all for the promise of a 68% pay cut, would you do it?  It seems unlikely that we are anywhere near a solution for this problem.  Perhaps an alternative would be a new “quarterback” of healthcare, an organizer of data or a focal point of our medicine who gathers the facts in efforts to provide synopsis to the physician.  Or maybe doctors charge monthly fees in addition to insurance payments.  They would be similar to cable companies.  Same week visits to your doctor could be the next HBO of the world.  Want to talk to a live human about your problems?  That’s an extra $5 on your statement!

It is no question that our healthcare system is in jeopardy.  It is unfortunate that we have a proposed solution when we don’t know all the questions to ask.