TMA Testimony by Doug Curran, MD
House Appropriations Committee
Subcommittee on Budget Transparency and Reform
House BIll 3791 by Rep. John Zerwas
April 16, 2013
Good morning/afternoon. I am Doug Curran, MD, a family physician from Athens and a member of the Texas Medical Association’s Board of Trustees. I am testifying today on behalf of TMA and its 47,000 physicians and medical students in favor of Committee Substitute House Bill 3791.
We hear a lot lately about how Medicaid is broken in Texas. Indeed, many parts of the system are badly in need of repair. When people who work in this building talk about a broken Medicaid system, you’re often talking about its spiraling, unsustainable cost to the taxpayers.
The people who work in doctors’ offices across the state are very sensitive to those costs — we are taxpayers too, after all. But when we think of a broken system, two more immediate, more pressing sets of concerns come to mind.
First are working poor patients who do not qualify for Medicaid, for whom Medicare is years away, and for whom private insurance is priced out of reach. I’m talking about uninsured patients like the 59-year-old woman with chronic congestive heart failure whom I see in a free clinic in Athens once a month. Except, that is, on those all-too-frequent occasions when she can’t afford her blood pressure medicine, and then I also see her in the hospital — where the bill to county taxpayers is much, much higher than the cost of paying for her prescription would have been.
And the long-term cost to her heart and lungs and kidneys is even worse.
There is also the cost to employers and the state. Patients with unmanaged, chronic conditions who cannot afford to see a physician regularly often miss a lot of work. Or they may not be able to work at all, so they and their family must rely on a whole host of public assistance programs to make ends meet.
The second set of physicians’ concerns goes like this: As Texas seeks a way to expand coverage to include my patient and a million and a half Texans like her, how do we ensure that we also provide real access to the regular, consistent health care services they need to stay out of the emergency department (ED) or hospital?
The most recent TMA survey found only 31 percent of Texas physicians accept all new Medicaid patients. That number has plummeted from almost 67 percent since the turn of the century. Another 26 percent accept Medicaid with limits. For lots of practices, this means the physician will only see patients to follow up from an ED or hospital visit, rather than actively accepting Medicaid in his or her practice. My colleagues and I want to care for low-income Texans, but we also run small businesses that have to pay our staff and overhead. Plain and simple, pitifully poor Medicaid payments are driving physicians out of Medicaid.
So how do we ensure current and any future patients can get the care they need?
- We can pay doctors Medicaid rates at least equal to Medicare. That will help ensure that Medicaid patients have a regular medical home for effective and affordable preventive and primary care and access to specialists when they are sicker or badly injured.
- We can streamline Medicaid’s 1,800-page rulebook for physicians and providers, and standardize the always-confusing and often-conflicting regulations and procedures used by the Health and Human Services Commission and the various Medicaid HMOs. That will reduce the frustrating amount of time and personnel physicians need to wade through a morass of bureaucracy and paperwork.
- Finally, we can redirect the Medicaid fraud inspectors — whose new regulations allow them to interpret any billing mistake as a target for prosecution without due process — away from “gotchas” for innocently crossing the line in that massive rulebook and toward prosecution for the aggressive, intentional fraudulent behavior that is costing us all millions of dollars.
For both economic and human reasons, Texas must find a way to improve Medicaid while simultaneously expanding coverage to low-income Texans. Yet, we know from our experience building the Children’s Health Insurance Program that a one-size-fits-all approach will not work. Texas physicians strongly support a homegrown solution that:
- Requires all patients contribute, even a little, to the cost of their care through modest copays;
- Establishes a Texas-specific benefit package that makes sense for this patient population;
- Simplifies the enrollment process and cuts through red tape for patients and physicians;
- Sets fair physician payment rates and allows us to test innovative new approaches to health care delivery;
- Uses federal funding mechanism that recognizes Texas’ rapidly growing population and diverse health care needs; and
- Ensures the state receives its maximum share of federal dollars, which in turn we can use to modernize and improve the Medicaid program.
If Texas does otherwise, patients’ new Medicaid cards will be nothing more than empty promises. And we will have failed. Because … in your building and in mine … people will still be talking about the broken Medicaid system.
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