By A recent subtext in the debate on health care reform has been about Medicaid's alleged failure to provide its enrollees with access to care - the argument goes that the parents and childless adults who would be added to Medicaid as a result of leading proposals would mean that 15-18 million people would be dumped into coverage where they wouldn't be able to see a doctor. As often is the case in Washington, the facts are considerably more nuanced than the talking points.
First, research is very clear that Medicaid has increased access to care and reduced unmet health needs for both children and adults. In fact, in terms of primary and preventive care, access to care in Medicaid is approximately equivalent to that in private insurance. Access to care issues in Medicaid are more likely to arise in certain specialties (most notably such as access to dentist care) and in certain geographic areas and they most certainly exist. But having Medicaid has been critical in improving low-income children's access to needed care.
We're all aware (perhaps from our own experience of trying to find a doctor who will take our insurance) that having an insurance card does not necessarily ensure access to care. I have virtually given up finding an internist that will take my Georgetown University Blue Cross plan. Doctors and hospitals pick and choose which insurance plans they'll take. A recent Center for Studying Health System Change survey asked physicians whether or not they were accepting new patients. Their answers varied by patient insurance type:
Yes, there are more doctors who are not accepting any new Medicaid patients, compared with those accepting new patients covered by Medicare or private insurance. But overall, more than 70% of doctors are accepting at least some new patients covered by Medicaid.
Now, people may legitimately say that adding an additional 15-18 million people to the program is likely to exacerbate access problems. It is true that adding that many people into the system requires consideration of the program's capacity to provide the care people will need. The most obvious solution -- an increase in reimbursement rates.
And there may be hope on the horizon for just such a solution. Following the health reform summit, the President has appeared to embrace this idea. The House included a provision in its health reform bill for a phased-in increase in Medicaid reimbursement rates and it also seems to have bipartisan support (Sen. Grassley (R-IA) raised it as an issue at the summit).
Medicaid has been instrumental in meeting the health needs of millions of children and families, and through health reform, the program would be expanded to meet the needs of millions more. So let's think about how to do that most effectively, but let's not use the access challenges, which happen in private and public coverage alike, to become an excuse not to do meaningful reform.
Thank you for this blog post. This is an issue the National Association of Children’s Hospitals cares about deeply. We have been working to ensure that health reform provides coverage for health care for more children, but also that the coverage provided results in children being able to get the right care at the right time at the right place. Today, physicians and hospitals that provide care to children receive inadequate reimbursement for their services, threatening the financial viability of the safety net for our nation’s children. Currently, Medicaid payments do not cover the cost of care, forcing many providers to limit the number of children that they see insured by Medicaid. As a result of low payment, many physicians either limit or do not accept Medicaid patients. This lack of access in the community forces a large number of children to seek care at their children’s hospital and this large demand for services results in delayed access to needed care. A recent survey of children’s hospitals (which house the greatest concentration of pediatric specialists) shows tremendous delays in scheduling specialist visits, resulting in delayed care and increased emergency room visits.
Recent cuts to Medicaid at the state level will affect the future supply of pediatric specialists. Lower Medicaid reimbursements add an additional barrier for physicians choosing a field, resulting in long wait times for our most vulnerable children accessing needed services. States are in a bind, with low revenues and the requirement to balance their budgets. They do not want to do any harm, but their options for filling budget gaps are extremely limited after consecutive years of budget pressures. Congress and the administration need to make a federal investment in children’s health care that will result in better access to needed services. Real health care reform needs to be enacted that works for children and improves their ability to access needed health care services at the right time in the right place.
For more ideas on what needs to be done to make health reform work for kids visit my blog, With All Our Might (http://www.childrenshospitals.typepad.com/withallourmight/).
Yes as long as you have the right amount of financial budget to support.Medicaid is a great support to continue to have a good service to it's people by providing the necessary support in doing such health service.