Beyond the "big" issues - like the tax on high cost health plans, employer mandates, and national versus state health exchanges - being negotiated by the House and Senate leadership, there are a myriad of other issues that have to be resolved before Congress votes on a final bill. In some cases, the differences are narrow, but for others, the bills take a very different approach to the policies, priorities and funding issues involved.
Take primary care. The House and Senate alike agree that primary care needs to be supported, and both bills have provisions to increase primary care workforce. But below the surface there is a big difference on how much money the federal government should spend on primary care, particularly when it come to increasing payments to physicians.
Both the House and Senate bills will increase Medicare payments to primary care physicians. But the House would also spend $57 billion over five years to increase Medicaid payments for primary care services so that they are on par with applicable Medicare rates. More than just primary care physicians would benefit under the House Medicaid pay parity proposal, since any physician - regardless of their specialty - who bills for the specified primary care services (mainly, office visits and other evaluation and management codes) would get the fee increase. The Senate bill does nothing to increase Medicaid pay rates.
Yesterday, the American College of Physicians joined with 118 organizations to urge House and Senate negotiators to include the Medicaid pay parity provision. The letter explains that, "Medicaid rates average just 66% of Medicare rates for primary care services and are woefully inadequate to cover the cost of providing care ... The inadequacy of Medicaid reimbursement levels must be addressed in conjunction with the Medicaid expansion or we risk leaving our poorest and most medically-vulnerable residents behind despite the remarkable promise offered by health reform." As reported in MSNBC several months ago, low Medicaid payment rates are the principal reason why few physicians accept large number of Medicaid recipients.
Both the House and Senate bills would add about 15 million more persons (mainly, adults without kids) to Medicaid, but unless the House pay parity provision is accepted, most of them will have a hard time finding a doctor who is accepting Medicaid. Jonathan Cohn writes in the New Republic that, "increasing the reimbursements in an existing public insurance program that already underpays doctors and hospitals would seem like a no-brainer--which, as it happens, it is, for a great many reasons." Also read Jacob Goldstein's Wall Street Journal blog on the same topic.
The House of Representatives is pushing for the Medicaid pay parity provision to be accepted in the final bill, but the $57 billion price tag is making it a hard sell for fiscally-minded conservative Democrats, who want to keep the total costs of the final bill below $900 billion. Still, expanding Medicaid to cover tens of millions more people won't give them access to care, unless Medicaid pay rates are increased to make it possible for doctors to take care of them.
Today's question: Do you accept Medicaid patients? Would you accept more if the Medicaid reimbursement was increased to no less than the Medicare rates?