Legislators should take "bold action to fix a major problem" in the Medicaid program and "increase Medicaid payments to Medicare parity for all physicians and services," Texas Medical Association President Michael E. Speer, MD, urged in a letter to House and Senate members writing the 2014-15 state budget.
"We know our request entails significant new costs," Dr. Speer wrote. "But fixing a Medicaid system widely acknowledged to be in need of significant repair will require bold action by Texas leaders. Regardless of whether Texas expands Medicaid or achieves any other reforms through a Medicaid waiver, millions of poor patients – your constituents – will continue to rely on Medicaid for their medical care. To be sure, other Medicaid reforms are needed, too, including improving patient outcomes and increasing use of preventive care, promoting greater patient accountability through use of copayments, and implementing payment reforms to promote better quality."
His letter included a chart comparing Medicaid, commercial, and Medicare payments for various physician services. It showed Medicaid payments range from 48 percent to 94 percent of Medicare and 42 percent to 75 percent of commercial insurance. "These rates are hardly enticing to physicians who may want to sign up for Medicaid, particularly when they can barely keep up with demand for their services from better-paying privately insured patients."
Dr. Speer pointed out a TMA 2012 survey showing that only 31 percent of physicians accept all new Medicaid patients, down 36 percentage points since 2000. Another 26 percent report accepting Medicaid with limits, he added, but that is troubling because more low-income Texans rely on Medicaid. And, state officials estimate 4.2 million Texans will be on Medicaid even if Texas does not expand coverage as authorized by federal law. "As you well know, a Medicaid card without a physician to provide care is no real access at all."
He also said TMA Physicians Medicaid Congress – appointed last summer to find ways to keep physicians in the system – concluded that "grossly inadequate payment was the single overriding reason physicians cited for why they or their colleagues limit or no longer participate in Medicaid." He said many physicians support Medicaid and want to participate, but "as owners of small businesses, facing ever more costly and demanding federal and state regulatory burdens, many just cannot afford to stay in a program that pays less than half their costs."
Dr. Speer concluded, "Like a rundown house in need of repair, you've got to pick up a hammer and start somewhere. Increasing Medicaid payment rates to Medicare parity is the nail that needs to be hit first."
Action, May 1, 2013