How Obamacare Will Hurt Doctors
17th January 2014
The reason for ER overuse is simple: Medicaid patients (like all insured patients) feel that their insurance card entitles them to health care anytime they want it. When office doctors aren’t available to provide it, they go to the hospital to get it.
But there’s a huge problem with expanding this mentality to ever more Americans, at least given the payment mechanisms in place for Medicaid.
Doctors aren’t available for Medicaid because it pays us poorly while highly restricting tests and treatments, including prescription drugs. Preventive services such as eye care, hearing and dental care are now being limited by most states. A 2013 study in Health Affairs revealed that only 67% of primary care doctors like me, and less than half of all specialists, accept Medicaid.
Even those doctors who do accept Medicaid are reluctant to do so, and many limit the number of Medicaid patients they will see. A 2008 Health Tracking Physician Survey showed that only 40% of physicians accept all Medicaid patients who seek appointments.Many Medicaid patients who lack a primary-care doctor see the hospital as the place to get all their care. It is not unusual for a Medicaid patient to come to the hospital for a urinary infection, and then ask if they can have their eyes or teeth checked while they are there.
But hospitals, too, are paid less for seeing Medicaid patients, approximately 85 cents on the dollar, and the last thing a hospital needs is a flood of new Medicaid patients rather than patients with private insurance.