Ten Miles Square


August 07, 2012 11:30 AM Medicaid. Again.

By Aaron Carroll

Yet another piece on how doctors won’t accept new patients with Medicaid. More specifically, another piece where doctors say they won’t take new patients with Medicaid:

About one in three doctors across the country doesn’t accept new patients who are covered by Medicaid, the federal-state insurance program that is supposed to enroll millions more low-income Americans as part of the Obama administration’s health overhaul, according to a new government study.
Some 31% of physicians in a sample of 4,326 said they wouldn’t accept Medicaid beneficiaries, economist Sandra Decker of the National Center for Health Statistics reported in an article in the journal Health Affairs published Monday. Most of the doctors cited the low reimbursement from Medicaid.
By contrast, 18% of the doctors said they weren’t taking new patients with private insurance, and 17% said they weren’t taking new patients who had coverage through Medicare, the federal program for the elderly.

I’ve said all this before, so I’m not going into too much detail. Here are the high notes. This is a report of what doctors say they are going to do in the future. Take that with a grain of salt. Doctors have a very good reason to say this. This is also due to low reimbursement which (1) the ACA starts to improve and (2) we could absolutely improve if we wanted to by allocating more to Medicaid, which is a cheap form of insurance. The “wait time” issue is caused by a too-small supply of doctors, which could also be fixed if we wanted. It has nothing to do with “Medicaid” in and of itself.

But the bottom line is that people are complaining that giving uninsured people Medicaid is a bad idea. Fine. Many of those same people didn’t want to give uninsured people private insurance in the exchanges, though, because that cost more. So now, when they argue against giving them Medicaid, they are essentially arguing for giving them nothing. At least for today. Sure, they’ll wave their hands at vague plans for somehow insuring the poorest among us, but I have not yet seen any comprehensive plan put forward in Congress with any real level of support that allows people in this socio-economic spectrum to be privately insured to the level that Medicaid covers.

And don’t be fooled into thinking that if we somehow took less money and handed it over to states in the form of “block grants” that they could somehow magically cover the same number of people and increase reimbursement to physicians.

Bottom line – YES, Medicaid needs to be reformed. YES, Medicaid could reimburse more. YES, Medicaid could be better. Almost everyone I know who supports Medicaid believes that. They want to do those things. They cost money, though. Somehow, those who don’t like Medicaid believe that it should be as good as private insurance, reimburse just as much, and somehow cost less.

P.S. More physicians reported in this article that they would take new Medicare patients than new privately insured patients. Remember that the next time everyone starts screaming that Medicare reimbursement is too low, no one will take it, and we need to get rid of that program, too.

[Cross-posted at The Incidental Economist]

Aaron Carroll ,MD, is an associate professor of Pediatrics and the associate director of Children’s Health Services Research at Indiana University School of Medicine.
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  • Dana on August 07, 2012 10:03 PM:

    Um. This isn't, or at least isn't just, "a report of what doctors say they are going to do in the future." It's what doctors do right now, and have been doing for at least 20 years. D*** few of them take Medicaid patients. A minority of doctors are taking ANY new patients, and a small minority of those take Medicaid patients.

    Get to know some people on Medicaid. You might learn something about the state of health care in America.

  • ShadowFox on August 08, 2012 4:32 AM:

    Dana is correct about the rate of physicians currently accepting Medicaid. But that's hardly a criticism of Carroll's piece.

    The point should be that the 31% figure that represents the number of doctors who claim they won't take new Medicaid patients cannot be interpreted in a vacuum. We need to compare that to the number of doctors who don't take new (or any, for that matter) Medicaid patients NOW and to the number of doctors who say they won't take new patients of any stripe. If the 31% figure is significantly higher than any of these, then we can discuss it. If it is not, then there is no news. If it's lower than the current numbers, then we've got the issue in reverse. But simply throwing out a number and pretending that it means something is utter hypocrisy.

  • Nikki on August 16, 2012 7:05 AM:

    Yes medicaid service is the best one for health care, every human must have the insurance coverage for health care.

    Medicare indiana

  • Medicare on February 01, 2013 2:22 AM:

    My vote is always for medicare as is the best plan which help many people when they are in need!!