Who needs Medicaid? - The Explorer: Columns

Who needs Medicaid?

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Richard D. Brinkley

Posted: Wednesday, August 29, 2012 4:00 am | Updated: 9:03 am, Sun Sep 23, 2012.

The federal government rules for Medicaid state that everyone has to have the same benefit package, regardless of health status or personal needs. In the private sector, one can choose from a number of benefit packages.

Due to the poor economy, states have been cutting Medicaid reimbursements to providers. Reimbursements are now so low that a Medicaid patient has great difficulty finding a physician. Health Affairs recently reported that a third of physicians, nationally, refuse to accept Medicaid patients.

With the passage of Obamacare and the addition of 30 million people to Medicaid, without corresponding increases in primary care and specialty physicians per 100,000 populations, the federal government has essentially rationed health care to the poor.

As a result of Obamacare -imposed physician rationing, more Medicaid patients are going to the Emergency Room for even routine services. In 1999, Medicaid patients visited the ER at a rate 3.5 times higher than private insurance patients. In 2008, of the 30 million ER visits by Medicaid and CHIP patients, only 14% were for immediate or emergent conditions.

Obamacare’s “reforms” are built around a strategy of expanding Medicaid without expanding physician capacity. As a result, Emergency Rooms utilization will skyrocket because of two factors: low physician reimbursement by government and lack of physicians willing to accept low reimbursement.

The American Action Forum (AAF) stated that Obamacare would expand the cost of healthcare nation-wide. AAF estimates that Obamacare’s design will generate 68 million visits and add $36 billion to the nation’s health care costs.

Further, Medicaid patients may be better off having no insurance rather than being covered by Medicaid.  Recent studies demonstrate that Medicaid patients suffer for it.

A 2010 study of 893,658 major surgical operations performed between 2003 and 2007, published in the Annals of Surgery found that Medicaid patients had the longest length of stay (and the highest hospital costs) and the highest risk of death. Uninsured patients were 25% less likely than those with Medicaid to die in the hospital.

A 2011 American Journal of Cardiology study of 13, 573 patients discovered that Medicaid patients who had coronary angioplasty were 59% more likely to have major adverse cardiac events than non-Medicaid patients.

An Ohio study published in the journal Cancer demonstrated that Medicaid cancer patients survive less time after their diagnosis than people with private or no insurance. The study tracked 11,000 patients with private or no insurance and 1,345 Medicaid patients. Of the non-Medicaid patients, fewer than 10 percent died within five years of their cancer diagnosis. More than 20 percent of Medicaid patients died during the five-year period.

Obamacare touts that the successful CHIP program will continue to cover 7 million children. If the program is so successful, why are Medicaid CHIP patients increasingly going to Emergency Rooms for routine childcare?

Obamacare touts that it modernizes and improves Medicaid through delivery system reforms while simultaneously saying that certain federal payments for certain health acquired conditions will be prohibited.

First, Obamacare slashes provider reimbursements, then it revokes certain health care coverage under the moniker “new and improved.” Medicaid is not health care. Obamacare touts new coverage for vulnerable Americans. What good is new coverage if there are no physicians to deliver the care?  Medicaid is a health care program in name only.

Medicaid recipients go to the Emergency Room for routine care because (1) they know that hospitals, by law, must treat them, even in a non-emergent situation; (2) Emergency Room physicians must treat these patients as a matter of law and hospital policy and (3) they know that they can receive medical services without payment.  

Further, the Emergency Room represents one-stop shopping. The Medicaid patient does not have to wait hours or days to receive medication or x-ray results.  Referrals are basically non-existent. Medicaid recipients may be poor but they are savvy customers of health care.

So, who needs Medicaid?

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