Cost of business: Industry experts respond to denial of Medicaid expansion
File Photo: Gov. Rick Perry's announcement that Texas would not expand Medicaid or form statewide insurance exchanges has drawn strong responses from both Republicans and Democrats.
When Gov. Rick Perry announced Monday that Texas would not expand Medicaid or form health insurance exchanges, reaction was mixed. Many Republicans praised the moves as fiscally responsible, while Democrats accused the governor of playing politics with the public's health.
One person not getting into the political mudslinging is Steve Love, president and CEO of the Dallas-Fort Worth Hospital Council. The organization represents 75 hospitals throughout an eight-county region of North Texas, including four hospitals in Plano.
"Hospitals treat people from all political parties, so I don't get into partisan politics," Love said. "We try and treat people and do what is right for the patients. I know Gov. Perry is being very conscientious and cautious and is trying to make sure he keeps the state's budget balanced, and we are very appreciative that he is doing that. But, where we as hospitals are disappointed is that the expanded Medicaid would really help in Texas."
Love said that with up to 27 percent of Texans having no insurance, the increase in federal funding the state would receive would go a long way to providing health care for uninsured Texans. He said approximately 1.2 million children in the state have no health insurance, and that 34 percent of Texas children live in poverty.
He said the state would have to pony up $6 billion if Medicaid was expanded, but in return would receive $76 billion from the federal government in Medicaid funding.
"We hope that we can sit down and get a lot of the stakeholders together and say, 'Look, how do we bring the $70 billion to the state and coordinate care, do what is best for the patient and make this a sustainable plan beyond 2020?'" he said. "Because if we don't, the amount of uninsured [Texans] is going to increase."
Texas not receiving the additional funds for Medicaid could also hurt local hospitals, which have already undergone a previous round of Medicaid cuts. In 2010 the American Hospital Association, in a good-faith effort to show support for the health care reform act, agreed to $155 billion in voluntarily Medicaid cuts. The Texas portion of those cuts equals $14 billion, Love said.
"Part of that agreement included the expanded coverage," he said. "We anticipated the expanded coverage, with the understanding that we would give $14 billion in reductions. Those reductions have already begun and if we do those and then don't do the expansion, we really didn't get what we agreed to."
Love did say the fact the federal government will come in and set up exchanges of its own should help decrease the number of uninsured Texans, despite Perry's refusal to set up the state exchanges. He said the exchanges will be especially beneficial for employed people who don't have employer-furnished insurance but make too much money to qualify for Medicaid.
Perry's announcement that the state would not expand Medicaid came at a time when a record number of doctors in the state are not accepting Medicaid or Medicare payments. A biennial survey by the Texas Medical Association found that only 31 percent of Texas doctors are accepting Medicaid patients, while only 58 percent are accepting new Medicare patients. These numbers are the result of a continued decrease in government reimbursements, said Michael E. Speer, the president of the Texas Medical Association.
"What's lost in the health care debate is the simple fact that patients need a doctor when they get sick. And physicians want to take care of patients and not push endless reams of paper around our desk," Speer said in a statement. "At some point, state and federal leaders must realize without an adequate network of physicians, no health care system can work, let alone be effective."
Speer's thoughts were echoed by several other doctors who said they opted out of Medicare or Medicaid because of the amount of government red tape.
Frisco physician Chris Noyes opted out of Medicare payments in early 2009, the TMA release said.
"I had a patient who moved from out-of-state to be with his kids," Noyes told the TMA. "He had lung cancer when he came in, and he ultimately died. We wrote off a fairly large balance. Two years after he died, we got a letter from Medicare saying they had overpaid for a flu shot for him by $2 and they wanted the money back with interest and a penalty, and if I didn't pay it all within 30 days they would prosecute me."
Su Zan Carpenter, a family physician in Angleton, told the TMA she eventually reached the point where enough was enough, and the amount of rules and regulations began to affect a her ability to treat their patients.
As far as the hospital council is concerned, Love said he believes it should be a priority to increase the number of doctors accepting Medicare and Medicaid patients. However, he admitted this will not be easy.
"The Medicaid payments to both physicians and hospitals are very low," Love said. "In most cases it is below cost. For example, hospitals get about 50 or 51 cents on the dollar for Medicaid. Obviously, Medicaid does not pay doctors as well as other insurance companies. We need to look at ways we can fix that payment."
Love said a system that is more attractive for doctors to treat Medicaid patients must be devised. One idea he said has been floating around is working out some sort of loan forgiveness on medical school loans if the doctor agrees to work in counties where there are not enough doctors and high levels of Medicaid patients.
Regardless of whether Republicans are able to successfully repeal the health care law, Love said it should be clear to people of all political beliefs that something needs to be done to fix health care in the United States.
"If the Patient Protection and Affordable Care Act is not the route to go, my question to the people who don't support that is, 'OK, lets sit down collaboratively and you tell us what we need to do,' because it is clear we need to reform health care," Love said. "The current system needs to be fixed. It cannot be sustainable on a long-term basis."