Latest posts by Jane M. Orient, M.D. (see all)
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The public relations campaign to support Medicaid expansion frequently uses testimony by patients with serious medical conditions who have lost their private insurance. It is assumed that once they qualify for Medicaid, they will easily get their chemotherapy, hepatitis c treatment, or defibrillator battery replacement.
“The messages talk only about coverage, not care,” states Jane Orient, M.D., executive director of the Association of American Physicians and Surgeons (AAPS). “But the real question is whether Medicaid provides access to care.”
An internet survey of AAPS members shows that about 47% of respondents think that it is more difficult for a Medicaid patient, compared with an uninsured patient, to get an appointment with a primary-care physician. Only 26% thought that the uninsured had more difficulty. For specialist appointments, 44% thought uninsured patients were better off, and 32% thought Medicaid patients were better off. Only 2% thought that Medicaid patients had “no problem” getting an appointment with a specialist.
When asked, “How easy is it for a Medicaid beneficiary to obtain drugs, medical equipment, or diagnostic tests?”, 48% said it could be “extremely difficult,” 27% said “moderately difficult at times,” and only 13% said it was “no problem.”
Of 166 respondents, 96 were physician specialists, 63 primary physicians, and 7 emergency physicians.
Open-ended comments were overwhelmingly negative about Medicaid. Rural patients who are unable to drive or travel may have no access to care at all except through charity. Some areas have no hand surgeons, endocrinologists, dentists, or rheumatologists who will accept Medicaid. Many cardiology tests, even echocardiograms on inpatients, are questioned or denied. Many drugs, even common generics, are unavailable without jumping through bureaucratic hoops. Treatment for chronic pain is especially difficult. It may be very challenging to get non-emergency surgery approved, no matter how necessary.
“Medicaid ends up as a jobs program for administrators and quasi-medical professionals,” writes one physician. “Very little of Medicaid money actually goes to the ‘health care’ part of the equation.” Another said that “poor customer service is the norm” and “excessive paperwork is routine.”
Because it may cost more to file a claim than a physician can hope to collect, physicians may lose on every Medicaid patient, and lose less if they just see the patients for free.
Stating that “denials were much more common than approvals for appropriate treatment options and diagnostic studies,” one physician concluded that “to expand such a horrendous program is insane.”
AAPS, which was founded in 1943, is a national organization representing physicians in all specialties.
[First published at the blog of the Association of American Physicians and Surgeons.]