Texas Politicians, Doctors Down on Medicaid
No Medicaid expansion in Texas, says the governor. Image by Todd Wiseman/Texas TribuneAudio clip: Adobe Flash Player (version 9 or above) is required to play this audio clip. Download the latest version here. You also need to have JavaScript enabled in your browser.
Gov. Rick Perry’s decision to opt Texas out of the federal Medicaid expansion comes as the largest doctor’s association in the state reveals that only a minority of physicians are even accepting new Medicaid patients.
The Texas Medical Association says fewer than a third of doctors in the state – just 31 percent — are taking on new Medicaid patients. Medicaid is the public health program for the poor; Medicare is for people over 65.
So why is the number so low? Association President Michael Speer says it’s because of low reimbursement rates and red tape.
“One way to think of it is if you had a grocery store and all of a sudden over the 10 years that you owned your grocery store, now you’re at 30 percent of the people walking into your grocery store aren’t paying for your groceries,” Speer said. “How could you keep your grocery store open?”
Medicaid reimbursement rates are set by the state, and they were among the things cut in last year’s legislative session. The new federal health care law aims to increase Medicaid reimbursement rates for primary care doctors up to the higher Medicare rates.
The law also aims to expand Medicaid to cover more people, about 1.5 million more people in Texas. But yesterday on Fox News, Gov. Perry made clear he doesn’t want that to happen.
“Medicaid is a failed program,” Perry said. “To expand this program is not unlike adding 1,000 people to the Titanic. You’re going to further drive this country into debt.”
Perry was empowered to opt out of the Medicaid expansion by last month’s Supreme Court ruling that said states can’t be forced into it. What remains unclear is whether opting out of the Medicaid expansion would disqualify Texas from receiving federal money to raise the reimbursement rate for Medicaid services.
Anne Dunkelberg with the progressive Center for Public Policy Priorities says it’s relatively new ground, because the Affordable Care Act wasn’t written with the anticipation that the Medicaid expansion would be crippled.
“Most of the scholars seem to assume that those provisions of the ACA were not affected by the court’s decision and provisions like the increased primary care rates are going to go forward for all states regardless of what their decision is,” Dunkelberg said.
But if less than a third of Texas doctors are accepting new Medicaid patients, would higher reimbursement rates have been enough for doctors to absorb the 1.5 million new patients added to the Medicaid rolls? The TMA’s Michael Speer says probably, but it would have taken a while.
“If they knew that these patients were coming down the line, and they knew how much money they were going to have available to hire new people, and given enough lead time, I think they could, over time, increase the capacity of the system to take care of these newly insured individuals,” he said.
But that is not likely to happen now that Perry is backing Texas out of a program that he says the state can’t afford.
Perry says he would rather see Medicaid money issued to states in block grants, so that they could develop their own programs to provide health care to the poor. It’s a proposal that has the backing of GOP presidential candidate Mitt Romney.
And if Romney wins the election in November, it’s still unclear how that would affect the health care law he has vowed to repeal.
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