Medicaid predicament

If Washington state is going to reverse the deterioration of health care access, it must solve its own Medicaid problems.

It is not right, in this society, for people to be denied access to good, routine medical care. Regular care can prevent manageable conditions developing into more serious, even life-threatening problems.

Just as neglect of personal health issues can lead to a medical crisis, the inattention to access concerns is creating a looming crisis for Washington citizens of all income levels. As today’s compelling news coverage shows, lack of regular medical care is already a fast-growing problem for people who qualify on Medicaid. As Herald Writer Sharon Salyer points out, this is just one aspect of a growing series of health-care access problems.

Leaders in health care institutions across Snohomish County have been agonizing and speaking about the troubles for more than a year. Along with counterparts from across the state, they have tried to gain the attention of policymakers in Olympia and Washington, D.C. The results so far are inadequate.

The state’s overly broad mandates for health insurance coverage remain in place. Nurses and other health care professionals remain in short supply, although training programs at community colleges and elsewhere show signs of gearing up. The glaring inequalities in federal Medicare payments for treatment of this state’s older residents have not been eliminated, but members of the congressional delegation are trying.

As complicated as the health care picture is, solutions are possible. Public demands for improvements are part of the answer, as will be some consensus on a balance of competing moral values. We must assure a reasonable level of care for all without imperiling the wonderful innovations achieved by a relatively free marketplace for medical care.

The Medicaid issue presents in a clear-cut way the growing threats to adequate care for much of the population. As scandalously low as the federal Medicare payments are, state reimbursements for doctors seeing Medicaid patients are much worse. Dr. Sam Cullison, president of the Washington State Medical Association, says that primary care doctors receive only about 20 to 30 cents on the dollar for their costs of seeing general Medicaid patients. The effects are particularly dramatic in Snohomish County, which is one of a number counties that have lost most possibilities for enrolling patients in a state-supported managed care program called Healthy Options.

Because of the inadequate reimbursements, most clinics are declining to see new Medicaid patients for basic care. The situation has contributed to a drain of experienced doctors and to the general inability to attract new doctors to Washington.

Options for remedies do exist. The 2003 Legislature can begin to figure out more equitable Medicaid reimbursements, even if it means facing hard decisions. The Locke administration and the Legislature must look at ways to fill the Healthy Options losses, whether through an overall fix or demonstration projects. And state leaders must begin looking at major changes to the overall health-care system. The deterioration is becoming a crisis.

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