Herald-Sun editorial: Medicaid changes bear watching

Dec. 26, 2012 @ 05:07 PM

In a story just before Christmas, The Herald-Sun’s Laura Oleniacz talked to a number of local health care leaders about an important change coming in the federal health overhaul: An increase in Medicaid fees for certain expenses from primary physician care. Medicaid is the federal health insurance program for people with low incomes.

The idea is to increase reimbursement fees to bring them into a somewhat comparable realm with Medicare reimbursements. That program provides health insurance for people over age 65 and people with disabilities.

As you might have guessed, the details and functions of this reimbursement increase are complex. The rates vary by state. North Carolina’s are higher than those in some other states.

“North Carolina’s rates are much closer to Medicare’s than they are in the country as a whole,” said Julia Paradise, an associate director at the Kaiser Commission on Medicaid and the Uninsured. “So naturally, the impact of the primary care increase that’s in 2013 and 2014 is going to be bigger in states whose rates are pretty low, compared to states more like North Carolina.”

This increase is by and large a good thing. With reimbursement rates rising, primary care physicians will be able to see more Medicaid patients; some providers are not able to afford to take on new Medicaid patients. Perhaps more importantly, with the proposed expansion of Medicaid, which is optional by state, and the reimbursement increases, which are not optional, physicians will be able to practice more preventive medicine for Medicaid patients, which would hopefully lead to lower overall costs in the long run.

“One of the hopes is that by investing in getting Medicaid patients access to primary care is so we can do health maintenance,” said Dr. Steven Stack, chair of the American Medical Association Board of Trustees. “We can treat their blood pressure, treat their diabetes, treat their other chronic illnesses before they become acutely ill. The hope would be we’d be able to save money … (and provide) better health and better quality over time.”

How this will all take shape remains to be seen. Covering more people through Medicaid will cost more in the near term. But chronic illness, visits to the emergency room, and patients who fail to get preventive care create huge cost burdens on our health care system. Providing better care – and earlier care – to Medicaid recipients has to help stem that tide.