Primary Care Physicians Lose In 2015

Many Americans trumpeted the millions of uninsured who obtained health coverage in 2014 via Medicaid or Obamacare exchange coverage. However, the Affordable Care Act made assumptions that all states would expand Medicaid coverage and this simply has not happened. In fact, 23 states have opted not to expand Medicaid leaving healthcare providers to face even more high uncompensated care costs.

Rubbing salt in the wound, Congress failed to extend Medicaid rate increase for primary care services before they adjourned at the end of 2014. The Affordable Care Act sought to increase Medicaid payments on par with Medicare. The thought process was that this would incentivize more physicians to see this newly expanded pool of Medicaid patients.

An analysis performed by the Urban Institute shows an average 2015 Medicaid reduction of 42.8%, with physicians in California, Florida, and New York being cut more than 50%. The Kaiser Family Foundation claims that 15 states are trying to find ways to cover some of the costs (in an attempt to keep Medicaid on par with Medicare). However, with many states already in a tight budget stance, it remains to be seen if and to what extent this will come to fruition.

So, now that the temporary two year hike in Medicaid rates has come to an end in at least half of the country, we may see a reverting of physicians opting to not accept Medicaid patients. With more patients now on Medicaid as a result of Obamacare, that would mean a larger number of patients having trouble getting access to healthcare than before the law was passed.

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Contact ABISA, a consultancy specializing in solo and small group practice management. Visit us at ABISALLC.com.

Obamacare led to an increase in ER visits

A recent study has shown a 5.6% increase in ER visits. The study by the Colorado Hospital Association included 450 hospitals in 25 states and demonstrated the increase is specifically due to the expansion in Medicaid. Moreover, the increase was three times higher than for hospitals in states that did not expand Medicaid. Additionally, the study implies that the newly insured Medicaid patients are sicker.

The Obama administration’s response? They claim they will educate these patients on how to obtain the right care, at the right place and time. I wouldn’t hold your breath on that.

Healthcare coverage was expanded and indeed that was a good thing for at least now those sick patients are going in to receive medical care. The problem is of course that the hospitals will have to figure out how to survive on Medicaid payments. Perhaps a time will come years down the road where patients will seek more preventative care via their primary care physician. In the meantime, however, hospitals are going to need to retool their operations and take a very hard look at their budgeting processes going forward.

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Contact ABISA, a consultancy specializing in solo and small group practice management. Visit us at ABISALLC.com.

New Plan for Health Coverage

Indiana Governor Mike Pence’s new plan to provide health coverage for more of the state’s low-income residents is another sign that few if any of the states holding out on Obamacare’s Medicaid expansion will do it in the way the law envisioned. The proposal also will test the Obama administration’s appetite to meet its coverage goals against its reticence to approve policies, such as cost-sharing requirements, favored by some conservatives.

Not counting Indiana, 23 states have yet to move forward with some form of expansion. Like several other Republican-led states, Indiana plans to apply for a waiver that will allow it to use federal Medicaid expansion funds to purchase coverage for adults earning up to 138% of the federal poverty level.

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Contact ABISA, a consultancy specializing in solo and small group practice management. Visit us at ABISALLC.com.