Earlier this week Gov. Rick Perry sent a letter to US Health and Human Services Secretary Kathleen Sebelius and stated that Texas is opposed to the expansion of Medicaid as provided in the Patient Protection and Affordable Care Act and to creating a state insurance exchange. This announcement came on the heels of the Supreme Court’s decision to uphold the PPACA.
Both decisions affect Texans as many Texans depending on government-funded health insurance face a crisis in access to health care. The problem is that having coverage is not the same as having access, and access to a waiting list is not access to health care. Handcuffed by stifling regulations and money-losing reimbursement levels, an accelerating number of physicians have stopped accepting new patients who have government-funded health insurance — Medicaid and Medicare. Only 31 percent of Texas physicians accept new Medicaid patients. The negative trajectory of this number is just as alarming, having been 42 percent in 2010. In Dallas County the numbers for 2012 are even more bleak — just 24 percent of physicians accept new Medicaid patients. At this rate you have to wonder when the acceptance rate for our county will fall into the teens, or if we will actually see single digits. Since 2010, the percentage of Texas physicians accepting new Medicare patients fell from 66 percent to 58 percent. In regard to dual-eligible (Medicare-Medicaid) patients, 40 percent of physicians statewide and 32 percent in Dallas County accept them. Coupled with the potential negative impact of the Medicaid 1115 Waiver on hospital reimbursement for low-income patients, we could be facing a devastating perfect storm of decreasing patient access.
This is why the proposed expansion in Texas of the Medicaid program under the PPACA by itself is not the answer for uninsured and low-income patients. Why expand coverage in an insurance plan that has shockingly limited and unacceptable access to care? This simply gives false hope to the 25 percent of our fellow citizens who are uninsured that their participation in the Medicaid program will dramatically improve their ability to access the healthcare system. We need a plan that expands coverage and access to care.
The gold standard for this access must embody timely access to quality, cost-effective care. A key ingredient of this expansion of access is the streamlining of the oppressive and progressively costly regulatory process so we physicians can devote more of our time to caring for patients and less to caring for paperwork. Paperwork never healed anyone. Improving patient access to health care also must involve increasing physician reimbursement to viable levels where we do not face the prospect of paying out of our pockets for every Medicaid patient we see. By working with our legislators and congressional representatives, we physicians can have a significant impact in improving access to the healthcare system for the uninsured of our state. We physicians must be forceful advocates for our patients. However, we should not put the cart before the horse. Instead of initially expanding coverage to the uninsured of our state to an overly flawed and ineffective insurance system, we should first concentrate our efforts on improving actual access to care through the Medicaid plan we currently have in place. Let’s get to work.
Richard W. Snyder II, MD
Dallas County Medical Society
I bolded the statements that I feel are particularly overlooked in the whole Obama Care kerfuffle. For more physician opinions on PPACA, including my own, see my Obama Care tag.