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Wednesday Dec 05, 2012

Tell Congress to Preserve Medicaid Parity Payments

When the Affordable Care Act became law in 2010, more than 48 million Americans -- roughly 16 percent of the nation's population -- were covered by Medicaid. Meanwhile, 36 percent of family physicians surveyed by the AAFP were not accepting new Medicaid patients because the health plan was offering payments far below the cost of providing care. In fact, nearly 20 percent of our members said they were not seeing Medicaid patients at all.

Nationally, Medicaid pays an average of 66 percent of Medicare rates for primary care services. In some states, it pays as little as 36 percent.

Today, more than 50 million Americans are covered by Medicaid, and the ACA calls for expanding Medicaid to as many as 21 million more patients. To increase the number of providers accepting Medicaid and improve access for patients, the ACA also increases Medicaid physician payments for primary care services to Medicare levels in 2013 and 2014. That's significant for family physicians because Medicaid patients already account for 15 percent of our patients.

Unfortunately, House Republicans are eyeing billions of dollars in Medicaid parity funds as part of an ill-advised solution to a different problem that Congress created -- and neglected to fix -- 15 years ago. A House leadership proposal sent to the Senate calls for eliminating the needed increase in Medicaid primary care payments to offset about $15 billion of the cost of extending the sustainable growth rate (SGR) formula for another year.

No doubt, the SGR needs to be extended for one or two years while we look for long-term alternatives for the flawed Medicare payment system. Physicians face a 26.5 percent reduction in Medicare payments on Jan. 1 unless Congress acts to block the cut.

But the House proposal merely temporarily bandages the Medicare SGR issue while eliminating much-needed progress on Medicaid.

The proposal overlooks the fact that expanding Medicaid coverage to millions of uninsured patients would not only improve their health, it also would reduce their reliance on costly emergency room facilities for non-emergent care, increase their use of preventive services and save federal and state governments money in the long run.

A study published earlier this year by the Commonwealth Fund showed that a 10 percent Medicare payment increase for primary care -- a provision of the health care reform law that took effect last year -- will increase primary care visits by roughly 9 percent. Although the costs for overall primary care visits are expected to increase more than 15 percent, the study estimates an actual overall 2 percent net savings for Medicare.

Raising Medicaid physician payments for two years would give us time to demonstrate similar benefits for that program.

The AAFP, the American Academy of Pediatrics, the American College of Physicians, the American Osteopathic Association and the AMA -- along with numerous constituent chapters of each organization -- are sending a joint letter to Congress detailing the importance of preserving the Medicaid parity funding during budget negotiations.

It is imperative, however, that legislators hear directly from you, their constituents. I urge you to send letters to your members of Congress and tell them to oppose the use of Medicaid parity funds as an offset for the SGR. We need to find a way to solve the SGR crisis without disrupting our patients' access to care.

Jeff Cain, M.D.is President of the AAFP.

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The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. All comments are moderated and will be removed if they violate our Terms of Use.