State must restore Medicaid payment rate

Washington’s Legislature needs to seize an opportunity this year to ensure continued access to health care for hundreds of thousands of low-income residents by extending reasonable Medicaid reimbursement rates.

Health care reform through the Affordable Care Act was designed to extend coverage almost universally in the U.S. to improve millions of people’s health and better manage health care costs.

While there have been hiccups in implementation, there has also been progress. A major way health care reform expanded coverage was through Medicaid.

But the promise of reform rings hollow for many covered by Medicaid, because reimbursement rates for services are so inadequate that doctors can be forced to choose between helping people of lower income levels or safeguarding their practice’s financial health. Current Medicaid rates are just 66 percent of Medicare rates for the same services.

National data shows that doctors are increasingly choosing to opt out of seeing additional Medicaid patients. Traditionally only 50 percent of physicians accept new Medicaid patients. A survey last year by Merritt Hawkins, a physician staffing and consulting firm, found only 45.7 percent Medicaid acceptance by physicians in 15 markets across the country.

The federal government temporarily raised Medicaid reimbursement rates closer to the actual cost of primary care in 2013 and 2014. But that was temporary, and today those rates have reverted to 2012 levels. As physicians’ costs rise and Medicaid reimbursements decline, it creates an impossible situation.

In our state, access to health care for Medicaid patients will be a growing challenge unless the Legislature takes action to restore reimbursements to the 2013-14 level.

Currently, The Everett Clinic and its physicians treat more than 38,000 Medicaid patients because we are committed to improving people’s lives through health and healing. We estimate the current Medicaid reimbursement rates are $5.7 million dollars a year below the actual cost of providing care. It is an open question as to how long we can continue to provide care for a Medicaid population if we are losing money providing those services.

Every medical group and physician who serves Medicaid patients faces the same dilemma. Restoring rates to 2013-14 levels would still put us below the break-even point, but it would help minimize our losses.

For patients, reduced access to care can be devastating. Losing a family doctor interrupts continuity of care, which is so important for young children and people with chronic conditions such as diabetes and asthma. Also, patients turn to emergency rooms for care, and health outcomes worsen, all of which results in higher costs and lost productivity.

In Washington, Medicaid serves more than one million low-income residents, including 672,000 children.

It’s important to remember the numerous benefits that expanded health care coverage provides. They include better health for individuals and families, increased productivity in school and at work, preventive medicine that can reduce the incidence of communicable diseases, and lower costs from identifying and treating health issues before they grow more serious.

Returning Medicaid reimbursements to last year’s levels will be a smart investment that will ensure lower income patients throughout the state can see their primary care doctor before more serious — and more expensive — complications develop.

Thus far 15 other states have taken action to extend higher Medicaid primary care reimbursement rates. Surely Washington can take similar action to help ensure continued access to health care for hundreds of thousands of our state’s residents.

Rick Cooper is the chief executive officer of The Everett Clinic.