Don’t hurt the clinics
Proposed change in Medicaid coverage would prove costly in the long run
Updated: 09/22/08 6:44 AM
Health care in the United States costs us all — individuals, employers and government — more than we can afford to keep paying. But simply refusing to pay for some forms of care, as the federal office in charge of the Medicaid program is proposing to do, is no solution.
That is particularly true when the proposed cuts would do the most harm to the poor and to the few clinics that are geared up to properly serve them.
The people who will not be able to pay for care will not disappear. The clinics that now exist to provide that care might. The result would be more people who are both sick and poor, placing more strain on whatever medical facilities might be ready to pick up the slack, and causing more suffering among people who won’t be able to find help.
The state of New York and its senior U. S. senator are complaining loudly about a plan to stop Medicaid payments for many patient visits to some hospital outpatient facilities, school-based clinics and other providers. Sen. Charles E. Schumer quotes state estimates that the new rules stand to whack those providers to the tune of $450 million a year in New York alone — $65 million of it to upstate facilities.
The idea is to limit payments for certain services from the federal-state Medicaid programs, which pay for health care for the poor, to the same amount paid for the same service by Medicare, the federal program that provides care for the elderly.
The problem is that many of those payment rates are lower for Medicare than they are for Medicaid, and many more would be for services that Medicare doesn’t fund at all. That would hurt patients who don’t need to be hospitalized but do need outpatient prenatal care, dental treatment, family planning services and mental health counseling — things that Medicare doesn’t have on its reimbursement list.
Medicaid officials are said to think they’d get more bang for your buck if poor people went to outpatient clinics less and to regular doctor’s offices more. And they might, if there weren’t so many regular doctor’s offices that won’t see Medicaid recipients because the payments are too low and the paperwork too much.
Sick people who don’t see doctors do not save the government money. They cost money, by getting sicker until they either present themselves at an expensive emergency room or just die, leaving fractured households and unsupported, and debt-ridden, dependents.
Schumer was heard to say recently that he had hopes that federal officials would back off on the rules because the people at the top of the bureaucracy admitted that they didn’t totally understand them.
Apparently.
