Stanley Feld M.D.,FACP, MACE
more complicated and expensive by the week. President Obama has intentionally
made the real costs of Medicaid more difficult to follow.
He originally fudged
the information to the CBO in order to obtain favorable scoring. The first
scoring created a deficit decrease of 108 billion dollars over 10 years. He
used this CBO scoring to convince the Democrats in both the House and the
Senate to vote for the bill.
Then the states that paid
most of the Medicaid bill complained. They
had budget deficits that would increase.
States are obligated by law to balance their budgets. The people could
not afford a raise in taxes.
President Obama said
he would pay 90% of the Medicaid bill for two years.
This would increase
federal expenditures for Medicaid. The increase was not calculated into the
original CBO scoring.
Now a study shows
that 33% of physicians will not accept Medicaid patients because the
reimbursement is too low.
This study is probably
not accurate. There will be less than 66% of physicians accepting Medicaid
patient. Physicians’ reimbursement has fallen below physicians’ operating
expenses. In 2014 Medicaid enrollment will explode. Under Obamacare an additional
16 million people will be eligible for Medicaid.
I wonder what is to
become of the other 16 million uninsured when the promise was to insure 32
Avik Roy pointed out that states with Democratic governors tend to have lower physician
reimbursement rates for Medicaid. Those Democratic governors have the highest
It is easier to cut
physicians’ reimbursement rates than reduce the already minimal services. Entitled
patients have been more vocal than physicians.
A higher percentage
of physicians will quit Medicaid. They cannot pay their office expenses with
the present level of reimbursement.
They will say, “I
If this happens and enough
physicians quit, these states will tell their licensed physicians that they
will not be able to renew their license to practice medicine unless they accept
I predict they will
prove true in a state like California, where 1.8 million residents are expected
to gain coverage – but fewer than 60 percent of providers presently accept new
patients in the program.”
President Obama anticipated
this in the Obamacare bill. The law increases Medicaid reimbursements for
primary care doctors to match those of Medicare providers.
The goal is to entice primary care physicians to participate in
There are several things wrong with this thinking,
- The increases are short term. The
Federal government will only increase payment for two years. Clearly if the
increase in reimbursement is successful it will have to be extended to maintain
the increase in participation. Some interest groups already have their eyes on an extension.
- The increases do not include specialists
so few specialists will participate at the onset, paralyzing the Medicaid system.
If President Obama increases payment to specialists the Obamacare deficit will
increase even further.
- Medicare reimbursement is decreasing and may end up being lower
than present Medicaid reimbursement. Therefore this entire exercise is another
Obama trick play.
- “As long as
a doctor or hospital isn't losing money, they will probably accept new
The key then, is Medicaid reimbursement. Federal dollars
will only last two years. It means states will have
an additional hundreds of thousands of Medicaid recipients for which they will be
on the hook for either keeping the
higher level of reimbursement once the money from Washington dries up, or cut reimbursement rates and watch
doctors bail out.
It is obvious the “fix”
is in, but without specialists included it will not work. Obamacare will have to subsidize the increase. This will increase
the federal deficit even more. In fact it will bankrupt the country.
apparently the plan all along. The two year funding was put in to reduce the initial
10 year costs and fool the public into thinking Obamacare costs less than it
This is only one of the trick plays that President Obama
included in Obamacare to deceive Congress and the people. Remember Nancy
Pelosi’s famous statement, “We will not
know what is in the bill until after we pass it.”
He spent money without attention to consequences.
The only sane thing to do is to repeal it and start over
again unless the goal is to bankrupt the country.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone
Please have a friend subscribe