Expanding Medicaid Saves Money — At a Steep Price
The Congressional Budget Office last week made a bit of news when it released cost estimates on two different health reform packages being considered by House Democrats, who are trying to bring the cost of their legislation down below $900 billion over 10 years. But, as The Washington Post pointed out, the cheaper version “would rely heavily on a more dramatic expansion of Medicaid.”
That strategy might be the cheapest way to get more people covered under the bill, but as we’ve pointed out here before, it comes at a steep price nonetheless: Namely, because so many providers don’t accept Medicaid, expanding the program’s reach doesn’t necessarily mean that the newly covered folks will have access to care. And what good is health coverage if doctors don’t accept it?
A September study from the Center for Studying Health System Change lays out the problem. After randomly surveying more than 4,700 physicians nationwide, the group found that just 40 percent accept all new Medicaid patients — a figure that drops to about 31 percent among family doctors and general practitioners.
For dentists, the figures are worse. A 2007 survey conducted by the American Dental Association found that just 27 percent of members accept Medicaid patients — a situation that’s left a dismal gap in oral health services under the program.
Not surprisingly, the primary reason that providers are reluctant to participate is the same reason that Democrats are eying a broader expansion: Medicaid, in many states, simply doesn’t reimburse as much as other plans. If you’re a doctor, that means you get paid less. But if you’re a lawmaker, that means you have to find fewer offsets.
Two possible solutions that we’ll never see: (1) Require that, in return for the privilege of practicing medicine in the United States, all providers accept all Medicaid patients, thus spreading the cost burdens evenly. Or (2) require that all members of Congress enroll in Medicaid. You can bet you’d see those access issues change in a hurry.