The June 16 article, “Health care’s ‘big lie,’” describes a major problem more evident in Snohomish County than almost any other part of the state. The Community Health Center of Snohomish County needs to be given much credit for continuing to bear much of the burden for the care of Medicaid patients. Ironically our county problem is magnified by the collapse of managed care and the state funded Healthy Options and Basic Health. Managed care was the first lie.
Next, came the big lie of expanding Medicaid to an even greater number of poor, without increasing the resources to do so. Washington was one of the first to extend its children’s coverage (CHIP) to 250 percent of the federal poverty level. When the feds caught up and funded that target, Washington state lost its share of funds because they had already made that effort.
I have just begun a term on the state’s Medicaid Title XIX advisory committee and would welcome input, since our county crisis is not so apparent to the rest of the state.
Washington is reimbursed $3,700 per Medicare recipient while many East Coast states are paid twice as much for the same services. Washington is generously subsidizing most of the other states. Medicare payments previously allowed physician practices to absorb losses of Medicaid, but now Medicare itself has become a negative transaction.
Our county experienced the demise of the Everett Family Practice and the Women’s Clinic. In Olympia, the 90 physician Memorial Clinic went bankrupt. It is estimated that for the year 2001 our state lost 200 physicians. The cumulative consequence of poor reimbursement has been the crumbling infrastructure of health care.
For years there are those who thought that the prime goal for health care was coverage. This is perhaps the biggest lie. What good is universal coverage if the result is no care?
Innovative solutions without increasing taxes could include the following: 1. Tax credit for providing free care. 2. Pay for care of the needy, not for coverage. 3. Oregon style rationing. 4. Roll back to tighter eligibility until reimbursement rates rise to the break even point. 5. Increase the Community Health Center role in the care of Medicaid patients.
Mill Creek
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