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Apr
03

Better Late Than Never

The headline says it all..."Cuts Leave Patients With Medicaid Cards, But No Specialists To See" but it was a not a headline on some tea-bagging conservative blog, no sir.  It was on the New York Times.  The stories it tells, however, are exactly what those who were opposed to ObamaCare were warning about.

Eight-year-old Draven Smith was expelled from school last year for disruptive behavior, and he is being expelled again this year. But his mother and his pediatrician cannot find a mental health specialist to treat him because he is on Medicaid, and the program, which provides health coverage for the poor, pays doctors so little that many refuse to take its patients....

...“Having a Medicaid card in no way assures access to care,” said Dr. James B. Aiken, an emergency physician in New Orleans.

Nicole R. Dardeau, 46, a nurse in Opelousas, La., in the heart of Cajun country, can attest to that. She said she could not work because of unbearable pain in her right arm. Doctors have found three herniated discs in her neck and recommended surgery, but cannot find a surgeon to take her as a Medicaid patient.

From her pocketbook, she pulls an insurance card issued by the Louisiana Department of Health and Hospitals.

“My Medicaid card is useless for me right now,” Ms. Dardeau said over lunch. “It’s a useless piece of plastic. I can’t find an orthopedic surgeon or a pain management doctor who will accept Medicaid.”

And while ObamaCare is not yet in full force, there are changes that are being made now as a result of current budgetary pressures and pending pressures from the effects of ObamaCare.  The realities, which many on the right warned about, are hard to ignore now for the Times.

The problem is common here and across the country, especially as states, scrambling to balance their budgets, look for cuts in Medicaid, which is one of their biggest expenditures. And it presents the Obama administration with a major challenge, since the new federal health care law relies heavily on Medicaid to cover many people who now lack health insurance.

Medicaid funding is eating up larger and larger chunks of state budgets - something that state legislators (like Utah's Sen. Dan Liljenquist and Minnesota's Sen. Steve Gottwalt) have been trying to address.

As we look at Medicaid costs that have doubled in 10 years and are on track to double again in another decade, we can safely say that Medicaid’s present growth rate is like the game of Pac-Man. It just keeps eating up state funds and is growing quickly, year-after-year. It is ravaging the state’s available funds and is completely unsustainable. Right now, 60 percent of the budget funds education. If that portion remains consistent through 2020, and we are committed to paying 36 percent to fund Medicaid at that time, then we are left with the remaining four percent of the state’s budget to take care of everything else. Without speedy intervention, Utah is committing entitlement-aided suicide.

Struggling Medicaid Administrators are just now asking the question that many on the write were asking over a year ago as the ObamaCare bill was being debated.

But for now the administration is counting on Medicaid to play a vital role in expanding access to care under the law President Obama signed last year. The program is already a major presence here, paying for 70 percent of births in Louisiana. State health officials estimate that the Medicaid program will grow by more than 40 percent as a result of the federal health law, with the addition of 467,000 new recipients to 1.1 million now on the rolls.

How can an already overtaxed Medicaid system handle such a huge influx of people?” asked Dr. Michael A. Felton, a family doctor in Church Point, La., near Lafayette.

It is a question being asked in many states. With the expansion of Medicaid to cover nearly all people under 65 with incomes up to 133 percent of the official poverty level (up to $29,330 a year for a family of four), Medicaid will soon be the nation’s largest insurer. It accounts for almost half of the increase in coverage expected under Mr. Obama’s health law, but has received less attention than other parts of the law regulating private insurance.

Emphasis mine.  This is a question that many of us on the right were asking - a legitimate question that the sages in DC and the NY Times didn't think to ask during the course of the debate on the bill.

Some of those that were demonized during the debate, the doctors, are trying to help, but it is an overwhelming prospect.

For patients like Draven Smith, whose mother said his behavior problems stemmed from attention-deficit hyperactivity disorder, the result is lack of access to doctors, especially specialists. For Draven’s pediatrician, Dr. Rachel Z. Chatters in Lake Charles, La., caring for poor children is a mission. About 80 percent of her patients are on Medicaid. It is, she said, frustrating to beg and plead with other doctors to see Medicaid recipients.

“I devote one afternoon a week, every Wednesday afternoon, to trying to find specialists for my patients — a pulmonologist for children with chronic persistent asthma, a neurologist for children with seizures or developmental delays, a psychiatrist for children with serious mental health problems, a hematologist for patients with sickle cell disease,” Dr. Chatters said.

However, it is a daunting task.  Governors and Medicaid administrators across the country are trying to figure out how to balance the needs of Medicaid with the needs of the rest of their states.

Bruce D. Greenstein, secretary of the Louisiana Department of Health and Hospitals, said, “We have a hard time finding specialists for Medicaid enrollees.”

Mr. Greenstein said the state expected to improve care and save money by enrolling most Medicaid recipients in managed care, an approach adopted by many states in recent years. In return for fixed monthly fees paid by the state, private health plans would coordinate the care of Medicaid patients, using networks of providers.

In passing the new health law, Congress wanted to make sure current Medicaid recipients would not lose coverage. Under the law, states generally cannot roll back Medicaid eligibility, but they can cut Medicaid in other ways — by reducing provider payment rates or by eliminating optional benefits.

About 20 states cut Medicaid payment rates for doctors last year, according to a survey by the Kaiser Family Foundation. At least 16 governors have proposed rate reductions this year for health care providers.

Gov. John Kitzhaber of Oregon, a Democrat, proposed cutting Medicaid payment rates for doctors, dentists, hospitals and nursing homes by 19 percent. Christine Miles, a spokeswoman for Mr. Kitzhaber, said his priority was to preserve eligibility.

In Illinois, Gov. Pat Quinn, a Democrat, has proposed reducing Medicaid reimbursement rates by 6 percent for hospitals and nursing homes.

Gov. Brian Sandoval of Nevada, a Republican, has proposed cutting Medicaid rates by 5 percent for hospitals, 15 percent for nonprimary care doctors and 25 percent for dentists.

In South Dakota, Gov. Dennis Daugaard, a Republican, just signed a budget bill cutting Medicaid rates for doctors, dentists, hospitals and nursing homes — even primary care physicians and pediatricians.

States have broad discretion in setting Medicaid payment rates. Federal law sets standards, but they are rather vague. Rates are supposed to be “consistent with efficiency, economy and quality of care,” and sufficient to ensure that services are available to Medicaid recipients at least to the same extent as to the general population in the area.

This is what happens when you pass a 2000+ piece of legislation that you have to "pass in order to know what's in it"...a piece of poorly written legislation filled with bad execution and good intentions.  It is time to scrap the ObamaCare and start over - with real reforms that do not demonize service providers...a bill that takes care of those in real need while making sure that those needs can be met tomorrow and into the next century.

Written by LL.