NC Medicaid Expansion: BAD for the Poor

Seems odd, right? How can providing more health care coverage to more people in need actually be BAD for the poor? Let me explain:

Essential to Medicaid is physician participation. Yet, Medicaid only pays approximately 60% of the total charge to a health care provider providing Medicaid services. For example, if a doctor charges $100/office visit, Medicaid would pay the physician $60. Therefore, most physicians refuse to accept Medicaid. In fact, in rural areas of North Carolina, where the percentage of Medicaid recipients is greatest, there can be a ratio of 200:1 Medicaid recipient to physicians accepting Medicaid. For some rural North Carolinians, the Medicaid card in their hand is worthless; people cannot find physicians accepting Medicaid. This scarcity of Medicaid providers becomes even more of an issue when it comes to dentists. A recent nationwide study indicated that over 60% of dentists refuse to accept Medicaid. The percentage grows if the dentist is a specialist.

What will happen if North Carolina accepts federal dollars to expand Medicaid? Approximately 720,000 more North Carolinians will be covered by Medicaid. But the laws do not require additional doctors to accept Medicaid. 720,000 more North Carolinians covered by medicaid means: many people holding Medicaid cards will have no doctor/dentist willing to treat them.

Obamacare does increase the amount paid to physicians accepting Medicaid in 2013 and 2014. But the increase is nominal (20%) and Obama has not explained from where the additional funds will come.

So how does “too many Medicaid recipients and not enough physicians accepting Medicaid” affect the real world? Let me tell you a story:

It is 2007 in Maryland. A 12 year old boy named Deamonte Driver complained to his mom that he had a toothache. Deamonte’s family depended on Medicaid for health insurance. Deamonte was eligible; he held a Medicaid card. Deamonte’s mom called and called and searched and searched for a dentist willing to accept Medicaid. Unsuccessfully. Sadly, unbeknownst to Deamonte’s mom, Deamonte suffered a tooth abscess.  Unable to find a Medicaid-accepting dentist, weeks later, Deamonte was admitted into the ER.  Deamonte’s bacteria from the tooth abscess, the tooth which could have been extracted for approximately $80, spread into Deamonte’s brain. After 2 operations and a 6 week hospital stay (for approximately $250,000), Deamonte died. All because Deamonte’s mom could not find a dentist willing to accept Medicaid.

Giving people Medicaid cards does not equal providing Medicaid recipients quality health care services…or even adequate health care services. Basically, this sham of of expanding Medicaid is just that…a sham. On paper, it appears that more people will be helped. And it is a GREAT marketing tool for politicians. Who would vote for the politician who said….we just cannot cover everyone with Medicaid? But, in reality, expanding Medicaid will make it harder for Medicaid recipients to receive good health service.

The disparity between the quality of health service to those people with private insurance versus those people with Medicaid reminds me of a sad part of U.S. history…when U.S. implemented “separate but equal” for blacks during the Civil Rights movement. In the pivotal case of Plessy v. Ferguson in 1896, the U.S. Supreme Court ruled that racially separate facilities, if equal, did not violate the Constitution.  Much later, Chief Justice Earl Warren, following the decision of Brown v. Board of Education of Topeka, stated that “separate but equal is inherently unequal.”  The general implications of the Warren Court opinion, however, are applicable to a great variety of separations, such as the separation of quality medical care for those people with private insurance and the sub-par health care for those people who depend on Medicaid for insurance. Separate is not equal. Giving more people a Medicaid card does not provide health service.

People with Medicaid deserve the same quality health care that people with private health insurance receive. But expanding Medicaid will do the exact opposite. More people will depend on Medicaid, and more people with receive sub-par health services…or worse, no health care at all.



About kemanuel

Medicare and Medicaid Regulatory Compliance Litigator

Posted on November 14, 2012, in Medicaid Expansion and tagged , , , , , , , , . Bookmark the permalink. 12 Comments.

  1. a very scary thought for our healthcare system, you would think with all of the number crunchers and analyst in our government that preventing
    failures is a lot cheaper than fixing them.

  2. Reblogged this on medicaidlaw-nc and commented:

    I think this blog is extremely pertinent and thought people should read it again.

  3. Great blog, continue the good work!

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