Sunday, December 28, 2014

"As Medicaid Rolls Swell, Cuts in Payments to Doctors Threaten Access to Care"

NYT: Just as millions of people are gaining insurance through Medicaid, the program is poised to make deep cuts in payments to many doctors, prompting some physicians and consumer advocates to warn that the reductions could make it more difficult for Medicaid patients to obtain care.

The Affordable Care Act provided a big increase in Medicaid payments for primary care in 2013 and 2014. But the increase expires on Thursday — just weeks after the Obama administration told the Supreme Court that doctors and other providers had no legal right to challenge the adequacy of payments they received from Medicaid. (read more)

16 comments:

Leland said...

Most people don't know that reimbursement is based on customer satisfaction. This is why there is no recourse to complain of inadequate payment. Customer Satisfaction is also note an individual thing, in which if you get a 4 out of 5, then you get 80%. Rather, it is a market comparable, so that if you get a 4 out of 5, in a market that tends to get 4.5 out of 5, then you are a lower tier provider and get a lower payment.

Welcome to large centralized government trying to come up with a one size fits all solution that is fair to everybody.

YoungHegelian said...

Wow! De facto rationing of medical care.

I mean, who could have seen that coming under ObamaCare?

AllenS said...

Every politician who voted for Obamacare should have to be covered by it. Them and their families.

edutcher said...

As predicted.

The Lefties will need all those slaves from south Of The Border 'cause the other ones will be dying off fast from now on.

Unknown said...

I prefer the large one size fits all government take a flying leap into a black hole.

Methadras said...

You know what is amazing. I tell the leftist I know that this was going to happen, and they have the nerve to tell me that medicare is more efficient than private insurance. Are you fucking serious? That's all you have?

Aridog said...

First of all Medicare is not the same as Medicaid. The latter is designed for the more or less indigent among us, under 65 yoa...so its almost sadly funny that it is the plan that is getting the ax. Is there nothing in the ACA that is sustainable? IMO...no.

Next, unless something has changed and I've missed it, all of Congress is required by stipulation in the ACA to get health insurance through the ACA "marketplace" ... with the caveat that the government will still pick up about 70% of the insurance cost.

Finally, I've read pundits that say the PPACA is roughly equivalent to the FEHBP...which I assure you it is NOT. I am insured under the FEHBP, via supplement now that I am on Medicare. My deductible is $147 per year, with nominal co-pays for most things...like $50 or less. Anyone hear of that in the ACA?

This precisely why I've advocated for adapting the FEHBP to nationwide use, with means testing of course, and voluntary participation by individuals and/or companies. Folks in both parties have agreed with me at times (John Kerry in 2004 & Daryl Issa in 2013)...and a big reason is that it already has a working infrastructure for over 50+ years now, and requires no added layering of new bureaucrats in an agency that has zero experience with handling such a plan...oh, and did I mention it already has a working database that is nearly flawless? Never mind that states would not have to set up "exchanges"...the main exchange is already set up and working, using private insurers,...as I said for 50+ years.

I am convinced the only reason the PPACA was passed was to force insolvency on everything else and force everyone in to a single payer system...like Medicare, but without the supplements. If that were the case now, I'd be both broke and dead by now.

Aridog said...

Going off topic, momentarily, since "rhhardin" doesn't post here (to my knowledge...but I hope he reads now and then)...his photo of "Julie" sleeping the chair is great...she's grown up to be a splendid dog. No way not to adore her.

PS: hope I have the new dog's name right, not sure I remember the name of his earlier dog...or if I have mixed it up.

KCFleming said...

The only thing socialism has never figured out is how to force people to give high quality service for free.

Even if you give them an elevatory ideology, no one works for free or for the fatherland.

Helluvathing.

Methadras said...

Ari, there are only two reasons and two reasons alone the ACA exists and that is to put private insurance out of business and move everything to single payer and to open the law books to allow the government to interfere in your life even more than it already has. The ACA is utterly invasive in it's predatory med-surveillance language. HIPPA? What HIPPA?

Michael Haz said...

The money statement is at the end of the article, typical for the NYT.

The fee increase was a good idea in concept, but it was built on an antiquated system in which doctors were paid a separate fee for each service.

Antiquated system? That would be capitalism. And the alternative is to force all primary car MDs into a system where the gov't employs them and pays their salaries. Isn't that swell? A FedGov managed HMO system. Total clusterspork.

I have two relatives currently in med school. They tell me that they see this scenario coming and don't want to be part of it. So they, and many of their classmates are opting out of primary care and into specialties like dermatology and anesthesiology. And the dread the day when med students will be told by the FedGov what they must train for.

Aridog said...

All I can say is that with a Medicare type system only, and no private insurance supplements, I'd be dead now...no way I could afford the deductible & premium costs of the relatively new and non-invasive treatment, under pure Medicare, that effectively saved my life. Twice.

You just have to know that irritates the hell out of me. There is no excuse for going away from the system that has cared for me, the supplemental insurance I carry is an HMO that has never, ever run in to the red ink. That treatment, a combination of Medicare and supplemental insurance, at a base cost to me of about $350 per month (individual coverage, non-family) out of about $800 per month total cost, a portion paid by my former employer in retirement.

I've looked, nothing in the PPACA comes close in out of pocket costs. N-o-t-h-i-n-g. And as I've already said, my HMO has never run in the red ink. Never.

Footnote: If, by chance, you run in to any substance abuse issues in Medicare, good luck finding a treatment center, if you chose that, in any facility that your normally trust. I had no choice but to go "cold turkey" once again...because I was stupid and back slide, for a while. Now conquered. Again.

Aridog said...

In short, in the end you are responsible for yourself. Decent insurance helps you...take it away and forget it.

Titus said...

I got lots of money for Christmas and am going to be getting lots more in the next few years.

I love money.

My parents, who came from nothing, and spent nothing, are giving me all their money and homes.

I am thinking about not working and what that means.

Although, I love working because I makes lots of money and value work.

virgil xenophon said...

Force Physicians to treat at any cost? Even Stalin and Head of the NKVD Beria combined couldn't force Doctors to practice in rural Siberia....and as one Judge recently ruled in Quebec Province: "A waiting list is not the provision of healthcare.."

President-Mom-Jeans said...

All that money won't save you from super aids, Titus.

You aren't getting Magic Johnson money.