Tuesday, September 30, 2014

All Obamacared Up and No Place To Go

This is a feature, not a bug:
Enrollment in Medicaid is surging as a result of the Affordable Care Act, but the Obama administration and state officials have done little to ensure that new beneficiaries have access to doctors after they get their Medicaid cards, federal investigators say in a new report.
The report, to be issued this week by the inspector general at the Department of Health and Human Services, says state standards for access to care vary widely and are rarely enforced. As a result, it says, Medicaid patients often find that they must wait for months or travel long distances to see a doctor.
Robert Pear of The New York Times writes that by 2016, an estimated one in four less well-off Americans will have been on the Medicaid rolls at some point during their lives. The Affordable Care Act mandates only that states provide adequate care for people on Medicaid, but somehow forgot to define the meaning of "adequate." To make it even more suspenseful, the public Medicaid program is now largely administered by private, for-profit insurers who, in the interests of the free market god, must also extract their fees.

In one state, the "adequate" waiting time for a sick Medicaid enrollee to see a doctor is as much as 60 days, Pear writes, while in other more humane places, two weeks is the acceptable norm. Regardless, few states ever bother to prosecute Medicaid providers who fail to uphold agreed-upon standards of care for the indigent. It's kind of the same rationale outgoing Attorney General Eric Holder uses for his failure to prosecute renegade bankers: with so few of them to begin with, the whole system would collapse upon itself if you dared punish anybody.

 The private insurance Medicaid contractors, wanting to stay in business in a bare-bones system, have also been known to deliberately falsify information on their so-called provider networks -- including the names of physicians who are no longer in business, who have already reached their quota of new Medicaid patients, or even those who've always refused to accept Medicaid patients. And in some cases, the providers listed are completely fictitious. Fraud? What fraud? 

It's not like the Obama administration couldn't have foreseen that physicians, who even before Medicaid expansion, were not accepting Medicaid patients. The reimbursements are much lower than what private insurers and even Medicare pays out. Although the Affordable Care Act provides for increased fees for physicians seeing indigent patients, these are only for the first two years of the program, like a bait and switch special introductory offer" for new cable subscribers. 

 There is also a chronic doctor shortage in the United States. There are too few medical schools training new doctors. The rural poor have more difficulty seeing a physician than the urban poor. From McClatchy Newspapers:
Of more than 1 million physicians, therapists and counselors nationwide, only 43 percent accept Medicaid, according to a new study by HealthPocket, a technology firm that compares and ranks health plans.
The situation varies by city. The study found that only 31 percent of caregivers accept Medicaid patients in Washington and Detroit, 36 percent in San Francisco, 42 percent in Philadelphia and San Diego, and 47 percent in Seattle.
“If the current Medicaid acceptance rates hold true for 2014, timely access to care for those relying on Medicaid is likely to become more difficult as enrollees compete for an already inadequate pool of doctors,” said Kev Coleman, the head of research and data at HealthPocket.
The lean physician workforce has prompted some states to try to expand the types of primary care provided by nurse practitioners, physician assistants and other non-physician medical personnel. But the HealthPocket study found that only 20 percent of physician assistants and nurse practitioners nationally accept Medicaid, less than half the rate of doctors and other providers.
But as Doctor Pangloss would say, it could always be worse in this best of all possible insurance- kludgey, exceptionally American worlds. At least the poor people who must wait weeks or months and crawl miles to see a doctor are lucky to live in states that actually are accepting Medicaid expansion. As a Harvard/CUNY research study shows, as many as 17,000 people are expected to die needlessly every year because they aren't even being afforded the right to wait in line and play the health care lottery game for the poor in the first place.

The richest country on earth not only boasts the greatest wealth inequality on earth: it's even divided its poor populations into subsets of misery depending on the party affiliation of their overseers.

Read more here: http://www.mcclatchydc.com/2013/05/13/191105/most-doctors-still-reject-medicaid.html#storylink=cpy


Pearl said...

And even Medicare doesn't cover everything -the last I heard only about 80% of patient coverage. Also reports of how the private insurers arrange their financial profits behind the scenes is obscene.
It will get worse. But we always have unending funds for endless wars in the U.S.
I would like to see a march like the one in NYC recently about the need for environmental reforms duplicated about the need for decent health care coverage. But as Jay has pointed out, it will take a long while to make inroads for change in this area.
Karen, this important column should also go to Truthout and glad to see your recent one published. Congratulations.
Although we have a much better health care system in Canada, it is beginning to have shortages due to the economic realities and only getting a better political party into power next year will attempts at change be attempted. Yes, we have a lot of wealthy people here creating inequality but not to the extent of the U.S.

annenigma said...


American Doctors in Africa wore protective gear and contracted it anyway. How, if it's so hard to catch except from blood and body secretions? WHO knows, and they're not telling. Fomites? Aerosolization?

A Texas hospital already turned away an Ebola patient and simply sent him home with some antibiotics (even though he had 'unremarkable lab results'). He returned in worse condition days later after likely infecting others, and they finally admitted and isolated him. That strikes me as being the norm in our medical system - if they can't quickly determine what's wrong with you or you aren't sick enough yet, go home with some antibiotics and come back if you don't get better. They come up with some vague diagnosis for reimbursement purposes. That's all that matters!

Most doctors have little to NO knowledge of infectious disease and wouldn't know one if it hit them up side the head.

The office staff are the first line of defense. How many bother even asking patients to cover their coughs let alone isolate them if they have one? They leave that up to signs in the lobby - isolate yourself please. How many doctors offices staffs will turn real cases away as they try to deal with the crowds imagining symptoms, or having similar but non-Ebola symptoms as we approach the Flu season?

Will the ensuing panic here in the US cause huge losses for the insurance carriers, or will the government bail them out their lost profits instead of simply giving us Universal Health Care? Will the media cooperate with the government in covering up info to control the panic? Will bodies have to be hidden like they were at Dover AFB for so long?

The health system is not prepared to cope with any infectious disease outbreak of any magnitude. Only if you've had the occasion to watch or read the government's scenario for a Flu pandemic would you know how dangerous and disruptive the public reaction alone can be, and Ebola is far worse a disease.

My guess that Homeland Security and defense contractors will handle and cash in on this instead of the government beefing up our public health system. After all, Obama sent thousands of TROOPS to Africa to help with their Ebola outbreak.

Oh, and despite what they claim about Ebola (and they may be right), many other viruses are most contagious BEFORE symptoms appear, not after. And exactly WHICH symptoms of Ebola heralds infectiousness according to the experts? The bleeding out?

The shit is about to hit the fan, just in time for Flu season.

Cirze said...

Here in NC, those of us without health insurance/Medicaid coverage are envious of those in other states who are waiting on a list for service.

The Koch-funded Rethugs in power here want us all to move away.

Love ya, Karen!