Doctor: Medicaid Patients Deserve Better

Published October 6, 2014

I wasn’t necessarily a fan of Herman Cain’s presidential bid, but I thoroughly enjoyed his tale of taking over as CEO of Godfather’s pizza chain and getting some of the best information on what was really happening to the company by talking with a bunch of 20-something (or younger) workers who manned the front lines as cooks and cashiers.

That thought occurred to me reading a recent post at KevinMD, a blog run by and for doctors and other health professionals. I regularly hear defenders of state-run healthcare explaining that Medicaid is a terrific program, and there’s no reason why we shouldn’t be expanding it to more people. I suspect if many of those defenders were to actually talk to the doctors caught up in Medicaid, they might learn something useful, as Cain did.

Doctors and patients deserve better than Medicaid

couple of pieces documenting the high percentage of physicians who refuse to take Medicaid patients, and some of the reasons for their refusal. One of my pieces prompted a physician to email me with his take on this matter. I am going to quote from that email…

Here’s what he said:

I had the experience of dealing with Medi-Cal (California’s name for its’ Medicaid plan) in the early 90s when I had started a primary care solo practice. Of 40 primary care docs in a 3 mile radius of my office, I was one of three who accepted Medi-Cal.

The payment for any office visit was so low that it bordered on punitive. The state paid approx 1/3 of the average commercial rate at that time and actually decreased the rate and payment over the past 20 years. California, perhaps not unique compared to all states, also had a nasty habit of stopping payment for any Medi-Cal billed services when the budget for that year ran out, even if that was after 7-8 months.Practices that absolutely depended on Medi-Cal reimbursement went unpaid until the start of the next fiscal year, at which time the backdue payments would trickle in until the next stoppage…

This is not unique to California circa 1990. For instance, at the end of 2013, the state of Illinois was about $1.9 billion behind in it’s Medicaid payment. So of course Illinois expanded its Medicaid program under Obamacare…