By KEVIN SACK
March 15, 2010
FLINT, Mich. — Carol Y. Vliet’s cancer returned with a fury last summer, the tumors metastasizing to her brain, liver, kidneys and throat.
As she began a punishing regimen of chemotherapy and radiation, Mrs. Vliet found a measure of comfort in her monthly appointments with her primary care physician, Dr. Saed J. Sahouri, who had been monitoring her health for nearly two years. She was devastated, therefore, when Dr. Sahouri informed her a few months later that he could no longer see her because, like a growing number of doctors, he had stopped taking patients with Medicaid. Dr. Sahouri said that his reimbursements from Medicaid were so low — often no more than $25 per office visit — that he was losing money every time a patient walked in his exam room. The final insult, he said, came when Michigan cut those payments by 8 percent last year to help close a gaping budget shortfall. “My office manager was telling me to do this for a long time, and I resisted,” Dr. Sahouri said. “But after a while you realize that we’re really losing money on seeing those patients, not even breaking even. We were starting to lose more and more money, month after month.” It has not taken long for communities like Flint to feel the downstream effects of a nationwide torrent of state cuts to Medicaid, the government insurance program for the poor and disabled. With states squeezing payments to providers even as the economy fuels explosive growth in enrollment, patients are finding it increasingly difficult to locate doctors and dentists who will accept their coverage. Inevitably, many defer care or wind up in hospital emergency rooms, which are required to take anyone in an urgent condition…
The inadequacy of Medicaid payments is severe enough that it has become a rare point of agreement in the health care debate between President Obama and Congressional Republicans. In a letter to Congress after their February health care meeting, Mr. Obama wrote that rates might need to rise if Democrats achieved their goal of extending Medicaid eligibility to 15 million uninsured Americans.
What a laugh.
As we know, the ‘healthcare reform’ package currently being rammed through Congress effectively requires far more drastic cuts to Medicaid (and Medicare).
In 2008, Medicaid reimbursements averaged only 72 percent of the rates paid by Medicare, which are themselves typically well below those of commercial insurers, according to the Urban Institute, a radical left] research group. At 63 percent, Michigan had the sixth-lowest rate in the country, even before the recent cuts. In Flint, Dr. Nita M. Kulkarni, an obstetrician, receives $29.42 from Medicaid for a visit that would bill $69.63 from Blue Cross Blue Shield of Michigan. She receives $842.16 from Medicaid for a Caesarean delivery, compared with $1,393.31 from Blue Cross. If she takes too many Medicaid patients, she said, she cannot afford overhead expenses like staff salaries, the office mortgage and malpractice insurance that will run $42,800 this year. She also said she feared being sued by Medicaid patients because they might be at higher risk for problem pregnancies, because of underlying health problems. As a result, she takes new Medicaid patients only if they are relatives or friends of existing patients. But her guilt is assuaged somewhat, she said, because her husband, who is also her office mate, Dr. Bobby B. Mukkamala, an ear, nose and throat specialist, is able to take Medicaid. She said he is able to do so because only a modest share of his patients have it. The states and the federal government share the cost of Medicaid, which saw a record enrollment increase of 3.3 million people last year. The program now benefits 47 million people, primarily children, pregnant women, disabled adults and nursing home residents. It falls to the states to control spending by setting limits on eligibility, benefits and provider payments within broad federal guidelines.
All of which will change, when under ‘healthcare reform’ the White House will be in charge of setting eligibility, benefits and most importantly, the payment for service rates.
Michigan, like many other states, did just that last year, packaging the 8 percent reimbursement cut with the elimination of dental, vision, podiatry, hearing and chiropractic services for adults… [S]urveys show the share of doctors accepting new Medicaid patients is declining. Waits for an appointment at the city’s federally subsidized health clinic, where most patients have Medicaid, have lengthened to four months from six weeks in 2008…
As physicians limit their Medicaid practices, emergency rooms are seeing more patients who do not need acute care. At Genesys Regional Medical Center, one of three area hospitals, Medicaid volume is up 14 percent over last year… New doctors, with their mountains of medical school debt, are fleeing the state because of payment cuts and proposed taxes. Dr. Kiet A. Doan, a surgeon in Flint, said that of 72 residents he had trained at local hospitals only two had stayed in the area, and both are natives.
Access to care can be even more challenging in remote parts of the state. The MidMichigan Medical Center in Clare, about 90 miles northwest of Flint, closed its obstetrics unit last year because Medicaid reimbursements covered only 65 percent of actual costs. Two other hospitals in the region might follow suit, potentially leaving 16 contiguous counties without obstetrics…
The New York Times makes a great case against the current ‘healthcare reform,’ without realizing it. For in the final analysis, Obama-care is really nothing more than Medicaid expanded to cover first the uninsured, and then eventually, all of us.
What these poor souls on Medicaid face we will all be facing in ten years – or even sooner, once private insurance companies have been completely driven out of business.
And then stories like this or worse will become commonplace, just like there are in every country that enjoys socialized medicine.
By the way, note the exotic names of the doctors in the article. Even doctors trained in the third world are rejecting Medicaid patients.
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When the government robs Peter to pay Paul, it can always rely on support from Paul. What happens when there are too many Pauls?
Sure you can trust the government, just ask an Indian.
"I never said I was worth it. I only said I wouldn't do it for less " William F. Buckley Jr.
And the incentives for innovating new, creative procedures will be what? And the incentives for inventing new drugs and undertaking the vast capital investment for getting them through the FDA approval process taking years will be what? With no profit incentive, advancements in phamaceuticals and medical procedures (medical instruments, equipment, etc.) will freeze or be substantially retarded. Seems to me that all of this information points to sucking the profit incentives out of the health care system.
And the incentives for innovating new, creative procedures will be what? And the incentives for inventing new drugs and undertaking the vast capital investment for getting them through the FDA approval process taking years will be what? With no profit incentive, advancements in phamaceuticals and medical procedures (medical instruments, equipment, etc.) will freeze or be substantially retarded. Seems to me that all of this information points to sucking the profit incentives out of the health care system.
I'm only making a what mil 6 this year instead of, what say a mil 8, Oh, I quit.... just shut my a@# down. PLEASE!!!! Are you flipp'n serious???? GET IN THE GAME! Know the #'s. Politics...YOU can have it....Shut the ........up!
Yesterday Walgreens announced that they will not be accepting any new Medicaid customers as of April 16th in the State of Oregon. The company has 121 outlets in that State. They will continue to service their existing customers however.
I have a first cousin who had her doctor retire, it has been eight months now and she has not found another doctor who is accepting more medi care patience. That ia in a SD city of about 60,000 population. I go to the VA and am afraid to sign up for Medicare even though I have been elbable for several years.
why should they accept the medicaid patients. I also agree with the new medications. If there is no incentive they will stop the research. Hey let BHO develop new meds, he says he and pelosi have all the answers. He wants to go down in history and i have no doubt that he will, unfortunately for all of us it will be for being the downfall of our country.
THINK ABOUT IT? WHY DO SO MANY FROM OVER SEAS, CANADA ECT ECT ECT.....COME HERE FOR ALLOT OF SURGICAL PROCEDURE? WHY DO THE BEST DOCTORS FROM OTHER COUNTRIES WANT TO COME HERE? WHY DO SOOOOOOOOOOOOO MANY PHARM COMPANIES STAY IN THE STATES WHEN ALL THE OTHER INDUSTRIES HAVE GONE OVERSEES? OK I am done yelling now but its because of the ................drum roll.............
More Doctors dropping medicaid patients
