Friday, December 14, 2012

Fwd: qotd: Medi-Cal could implode

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-------- Original Message --------
Subject: qotd: Medi-Cal could implode
Date: Fri, 14 Dec 2012 10:31:40 -0800
From: Don McCanne <>
To: Quote-of-the-Day <>

Los Angeles Times
December 13, 2012
Court ruling could cut California spending on Medi-Cal
By Maura Dolan and Chris Megerian

A federal appeals court decided unanimously Thursday that California may
cut reimbursements to doctors, pharmacies and others who serve the poor
under Medi-Cal.

A three-judge panel of the 9th Circuit U.S. Court of Appeals overturned
injunctions blocking the state from implementing a 2011 law that slashed
Medi-Cal reimbursements by 10%. Medi-Cal, a version of Medicaid, serves
low-income Californians.

The ruling could make it harder to find doctors for as many as 2 million
new patients who could become eligible for Medi-Cal under President
Obama's healthcare law — a possible 25% expansion of the program.
California already provides one of the lowest rates of reimbursement in
the nation for medical services to the poor, and there is a shortage of
doctors to serve those patients.

According to the California HealthCare Foundation, Medi-Cal patients
already have difficulty finding doctors.

A foundation study published in July 2010 said 25% of physicians
provided care to 80% of Medi-Cal patients.

Although 90% of physicians told the foundation they were accepting new
patients, only 57% said they were taking on new Medi-Cal patients.,0,4784104,full.story

Comment: One of the major defects in the Affordable Care Act is that it
perpetuates and expands the Medicaid program - a welfare program for
low-income individuals. Because of political anti-welfare bias, it is
vulnerable to budget cuts that would not be tolerated in a program like
Medicare that benefits all of us.

California's Medicaid program, Medi-Cal, exemplifies this problem. It
has one of the lowest payment rates in the nation, not even meeting the
expenses of many of the physicians still willing to see these patients.

There are already over 7 million Californians on the program, and there
will be almost a million children added as California shuts down its
CHIP program (Medi-Cal pays less than CHIP). There will be about 2
million more individuals added in 2014 under the provisions of the
Affordable Care Act. Further, low-income Medicare patients also eligible
for Medi-Cal are being transferred into Medicaid managed care plans.

In spite of California being at the bottom in Medicaid payment rates,
this 9th Circuit Court of Appeals decision upholds the additional 10
percent cut enacted because of California's budget crisis. The reduction
was challenged based on the fact that federal law requires that the
state ensure that Medicaid patients have access to adequate health care
services, and underpayment reduces the number of willing providers. That
argument was rejected by the court, though it is difficult to see how
California's physicians will be able to care for over 10 million
Medi-Cal patients when they are effectively donating their services plus
subsidizing their losses resulting from overhead expenses that are
greater than reimbursement rates. As more physicians turn them away, the
crowd out of privately insured patients will threaten the solvency of
the few remaining dedicated physicians.

This underpayment has real consequences. Access to primary care is
impaired, and specialized services are especially difficult to obtain
since most specialists are particularly resistant to allowing these
patients in their practices, no matter how great the need. Outcomes for
Medicaid patients are not as favorable as for those who have Medicare or
private insurance. In some studies, the outcomes are as bad as the
outcomes for the uninsured.

What good is a Medi-Cal card if it won't provide access to health care?

If we had a single improved Medicare that covered everyone, this problem
wouldn't exist. Everyone would have the level of care that we should
expect from a high-performance health care system. Are there too many
politicians who still believe that we should offer only inferior health
care to the poor because that is all they deserve? The rhetoric of the
recent elections doesn't bode well for a more egalitarian approach.

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