The NC Medicaid System is Broken: FIX IT!!

People covered by Medicaid receive worse medical service than people with private insurance.  This is a fact.  It is a sad fact, but a fact nonetheless.  Hundreds of studies have shown this fact.  Here are a few:

A recent study published in the New England Journal of Medicine examined pediatric access to specialty clinics in Cook County, Illinois.  The study sent out research assistants posing as mothers and making phone calls to a random sample of specialty clinics, the study found a significant disparity between access to specialty care for privately insured children and children on Medicaid as well as the publicly funded Children’s Health Insurance Program (CHIP). Specifically, the researchers noted more denials of appointments as well as longer waiting times for Medicaid and CHIP patients than for privately insured patients.

A very scary study conducted on North Carolina‘s Medicaid in 2010 published in the State Center for Health Statistics, found that the North Carolina Medicaid population experiences a much higher rate of overdose deaths than the North Carolina population. This study suggests that fatal overdose among the Medicaid population are associated with claims for mental health disorders, substance abuse, and routine medical care for pain management.

A 2000 study published in the American Journal of Public Health that examines colorectal cancer treatments and outcomes found that Medicaid patients not only had higher mortality rates, but were also less likely to receive cancer-directed surgery, than patients using commercial fee-for-service insurance.

A 2010 study in the Journal of Hospital Medicine found similar results for non-cancer-related illness. In this study, the authors examine the relationship between insurance status and health outcomes for myocardial infarction, stroke, and pneumonia patients.  The authors statistically analyzed a nationally representative hospital database and noticed, even after adjusting for factors such as age, gender, income, other illnesses, and severity, higher in-hospital mortality rates for Medicaid patients than for privately insured patients. Additionally, even after adjusting for these factors, the study found that Medicaid patients hospitalized for strokes and pneumonia also ran up higher costs than the privately insured, as well as the uninsured.

A 2012 study in Health Affairs examined physicians’ willingness to accept new patients. Using survey data from a nationally representative sample, the study found that nearly one-third of physicians nationwide will not accept new Medicaid patients. Doctors in smaller practices, as well as doctors in metropolitan areas, are among the least inclined to accept new Medicaid patients.

So, with the understanding that  the Medicaid system  is failing those very people it is designed to protect, why are our political leaders ignoring the broken system and merely dumping more people into the failing Medicaid system????

With Obamacare‘s Medicaid expansion, hundreds of thousands of people will be dumped into this broken Medicaid system with zero political effort to FIX the system. In NC alone, if we expand our Medicaid, approximately 720,000 more North Carolinians will be Medicaid eligible.

Obama proponents would, most likely, argue that Obama raised the Medicaid reimbursement amount to physicians to meet the Medicare reimbursement rate. Raising the Medicaid reimbursement rate tempts more physicians to accept Medicaid.

I agree with the last sentence of the above paragraph. Raising the Medicaid reimbursement rate WOULD cause more physicians to accept Medicaid. But that is not what Obamacare does.  Obamacare does not raise the Medicaid rate to all physicians, only primary care physicians, and only temporarily.  And even the raised rate for primary physicians is nominal, at best. Because, during the 2012 election,  while Obama was standing on his platform of higher Medicaid reimbursement to physicians…up to the Medicare rate….Obama was slashing the Medicare reimbursements. It’s the old bait and switch. GOTCHA!

Again I ask: Why are our political leaders ignoring the broken system and merely dumping more people into the failing Medicaid system????

Medicaid expansion will cause more people to be declined medical treatment by providers, cause people to receive sub-par health services, and to the extreme, cause deaths when those deaths should not have happened.

Unintentional overdosed (UO) deaths have become the second leading cause of unintentional injury deaths in the United States, exceeded only by motor vehicle injuries. (1)  North Carolina UO death rates exceed the national average.  The Medicaid population represented approximately 20 percent of the overall state population in 2007, but it experienced one-third of the unintentional overdose deaths.  (2)

Instead of expanding Medicaid to more people,  our leaders need to fix the Medicaid system first. Fixing the Medicaid system should be the number one top priority.  Not exasperating the problem by dumping 720,000 more North Carolinians into the Medicaid system. FIX IT!! 

Make sure that if I hold a Medicaid card that (1) I am able to get an appointment with the proper physician; (2) that the physician I visit does the very best he or she can to ameliorate my problem (as if I were on private insurance); (3) provide me with any needed test to determine the cause of my problem; (4) allow me to have follow up appointments.

In essence, those with Medicaid should receive the same care as those on Blue Cross (not saying Blue Cross in the bee’s knees).



About kemanuel

Medicare and Medicaid Regulatory Compliance Litigator

Posted on December 18, 2012, in Affordable Care Act, Medicaid, Medicaid Expansion, Medicaid Funds, Medicaid Reimbursement, NC DHHS, North Carolina, Obamacare and tagged , , , , , , , . Bookmark the permalink. 2 Comments.

  1. Hi! I could have sworn I’ve been to this site before but after reading through some of the post I realized it’s new to me.
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