Streams

Expanding Medicaid, But Limited Care Options

Friday, January 03, 2014

As millions of people get healthcare coverage through the Medicaid expansion, will there be enough doctors to go around? WNYC reporters Jessica Gould and Fred Mogul discuss this change through the Affordable Care Act, as well as the news today (reported in Science) that when Medicaid expanded in Oregon, emergency room use went up -- not down.

Doctors: do you accept Medicare/Medicaid? Why or why not? And patients: are you finding doctors that do accept Medicare/Medicaid? Call in and tell us at 212-433-9692, or leave your comment below. 

Guests:

Jessica Gould and Fred Mogul

Comments [33]

@lyn from NY

"I don't know why doctors aren't ALL required to accept some number of Medicaid patients. Lawyers are required to provide free (pro bono) services as part of keeping their license or risk a fine."

There is NO SUCH REQUIREMENT for attorneys who are already admitted to practice law in the State of New York.

Please provide a link to any material you think states otherwise.

Jan. 24 2014 03:44 PM
LB from Manhattan

If you're on Medicare and live in Manhattan, it's very hard to find doctors who accept it. Doctors just out of training are pretty much your only option. I had to switch from my gynecologist who doesn't accept Medicare. Blame it on reimbursement rates and tons of paperwork, doctors tell me. Brian, it would be great if you did a show on this.

Jan. 03 2014 03:59 PM
RUCB_Alum from Central New Jersey

Wow, Eileen. It's a really, really bad idea to put your phone number on a blog.

Jan. 03 2014 01:07 PM
Eileen from NJ from Highlands, NJ

Dear Brian Lehrer,
Thank you very much for the sunshine on the problem of the new Medicaid Obama expansion system in New Jersey. For the first time in NJ, single adults are elegible. My daughter was declared eligible by the healthcare.gov (after many long sessions)but we can get no further. She was told that she will be contacted by New Jersey Family Care. We have called many times to enroll by phone. The prompts take you to where you expect to be able to enroll. Instead of joining a queue, even if a very long one, you are then disconnected with a very generic message saying you reached the wrong number. Clearly you are just dumped from the New Jersey Family Care phone tree. This happened 4 times on Jan 2nd and so far 3 times today.

The New Jersey Family Care website urges you to enroll on online but that is impossible as all choices go to error messages.

PLEASE PLEASE follow up on this topic again !
Regards from devoted listener.

Eileen in New Jersey
201-486-0344

Jan. 03 2014 12:48 PM
RJ from prospect hts

Lisa, I don't want to make this personal, between you and me. But I want to reply, for others who read your posts, to a couple of things you've said. First, have you spoken to the many ACA navigators who help people with problems like yours? There is the Community Service Society, the Centers for the Independence of the Disabled, among many others, that can help you find help. Second, I am 56 and have been a Type 1 diabetic for 46 years, and am also a freelancer. The ACA has not taken away my insurance; it has replaced it with something less expensive and added people who have never had care at all.

If you must see this from the point of view of people who have had insurance, consider how ill you've become because the uninsured were walking around breathing out infection, coughing or sneezing into the air of the restaurants (fast food and otherwise) that refuse to either pay for insurance or pay them enough salary to afford it themselves--or give them paid sick time. My "fabulous" insurance cost me $17,000 a year, not counting copays, coinsurance, etc, and I am not a high-priced consultant; I am at 197% of the federal poverty level. Because of some specialized--out of network--care that I need, I will be paying about $7,000 out of pocket with my NYState of Health plan--but still less than I was prior to the ACA. I have never had the funds to buy my own apartment, so please forgive me if I am a bit less than sympathetic to your situation.

You can still buy insurance directly from a private company, if it turns out that the New York State exchange does not have a plan particular to your situation (and they are still covered by the "no discrimination against those with pre-existing conditions provisions), so the funds you paid for your fabulous plan can still be put to good use.

Last, I find it a bit ironic that someone who has had a "fabulous" plan can write: "People seem to think this is a non-issue, because it is happening to someone else. But you would be screaming to high heaven if it were happening to you!" Have you, prior to this time, considered what happens to the millions upon millions of uninsured? Was that a non-issue for you?

Jan. 03 2014 11:39 AM
Amy from Manhattan

I agree w/RJ about the "ludicrous convolutions" that are a preexisting condition of the medical system. After my accident in Feb., my descriptions of the difficulties involved in getting my records to the doctors I needed to see went from "convoluted" to "byzantine" to "Kafkaesque"! Hospital employees kept telling me, "Just come in & pick them up!" (I think there was 1 time someone left out the "Just.") But the hospital was 3 subways away, & my mobility was limited, & it took me 3 months to get my records to my PCP so I could get the primary care & referrals to specialists that I needed. It is beyond ridiculous. It is hazardous to our health. I hope Jessica Gould & Fred Mogul can look into this & whether it will change w/PPACA.

Jan. 03 2014 11:16 AM
Hey "Doctor" Justin

Shlubs like "Doctor Justin" are who we can thank for earning the U.S. our rightful place at the bottom of the barrel in terms of first world health care. Thanks a lot you selfish a-hole. If you want to get rich, stand up to the insurance companies or make some calls to your congressman and the AMA. Ripping off peoples' grandmothers is real classy.

Jan. 03 2014 11:02 AM
Sheila from central New Jersey

I heard the first caller say that Medicare pays about $135 for an office visit. That means that when I sign up for Medicare later this year, my endocrinologist will be getting more on my behalf than my employer-based (retiree) plan pays him now -- about $74. He definitely takes Medicare, if the mix of his patients is any indication.

Jan. 03 2014 10:49 AM
The Truth from Becky

"CHARITY?" - I pay a massive amount per year for medical insurance, as a single person always have and I hope I never had a doctor who thinks like Justin! I would fire him in a heartbeat! Charity, move to Beverly Hills snob.

Jan. 03 2014 10:45 AM
Dr Justin from Brooklyn

After working like dogs for years to get into med school, through med school, through 100 hour weeks in residency, setting up a business etc, is it the physician's duty to provide charity for the "right" to practice medicine? It is a "right" won by sweat and tears.'

Jan. 03 2014 10:41 AM

Martin Chuzzlewit doesn't understand that we have worse than third-world level healthcare for many people in the United States already. I spent many years working with health care systems in West Africa, South and South East Asia and a little bit in Latin America. At least there you have community doctors rather than emergency room care. When people go to the emergency room rather than doctors it increases the cost to those of us who are self-employed to a greater extent than anyone else because a) we have to compete against big companies who can leverage lower insurance rates, b) we have to pay more in taxes than either those who are employed by large companies and the fact that many of those companies receive government incentives, and c) we have to pay more in health care costs period because of the lack of preventive care from a system that focuses on withholding such care from those who don't receive a sufficiently large wage to afford health insurance.

Nevertheless, I am really angry that the Affordable Care Act kicked those of us who paid ridiculously high health insurance rates to begin with because we are self insured to the curb. Now our rates are even higher than the $20,000 per year we were paying and cover less. The health insurance executives are laughing all the way to the bank with their windfall and their deliberate schemes to make sure that the fine print on your health insurance policy is even more obscure and difficult to understand than the derivatives market.

Jan. 03 2014 10:40 AM
Sheldon from Brooklyn

Only when the government starts helping doctors with their student loans or with other incentives, should they feel the right to require doctors to work for less than market rate.

Jan. 03 2014 10:40 AM
NER from NJ

Lisa: I'm sure you must know more about the subject than you've explained, but I don't understand why you say that you have to pay back Medicaid "loans." I thought that was only for non-covered services. How often would that occur?

Also, as far as your apartment is concerned, I also understood that Medicaid eligibility provides for home equity exemptions of up to $500,000 in some states. What is the home equity exemption in NY?

Jan. 03 2014 10:39 AM
hicoachrich from murray hill

thank you, dotorre...too bad coverage had to go to snow and Mayor De---he was magnanimous and thoughtful...and informative on a very real-world, practical level

Jan. 03 2014 10:34 AM
RUCB_Alum from Central New Jersey

Doctors' salaries are so high because the cost of educating a doctor in the US is so high. How about we expand the existing 'army doctor' program now used by the military and provide a nearly free education for qualified med students and nurses IF they give ten years of public service - Medicare, Medicaid, VA, etc. Not as radical as starting a sixth service branch that I have asked for before but it is a step to a better way.

The brain drain that is pulling all of the best and the brightest into banking and finance also has an impact on our ability to take care of many other things that a modern civilization needs. Engineers, teachers, air traffic controllers...the list is pretty long.

I'll say it one more time...College tuition has grown at the rate of GDP growth, while incomes are tied to CPI which is two points below GDP. That sort of disconnect cannot be maintained.

Jan. 03 2014 10:33 AM
fuva from harlemworld

Seems that the low rate of Medicaid acceptance
explains the stat reported this morning about
high rates of ER use amongst Medicaid recipients...
They can't find doctors.
On top of that, they are not yet socialized
to visit doctor's offices,
as HudsonDC points out.
Once again, we have a multifaceted modern problem
requiring multifaceted solution.
Folks, we can do it.

Jan. 03 2014 10:31 AM
jgarbuz from Queens

The first time in my life I felt sorry for doctors was when I went to live in Israel back in the 1980s. I was actually making more as a technical writer than most doctors were making under their semi-socialist system at the time. And their surliness at the clinics showed it.

I say go back to capitalist + charity medicine, where doctors will have to contribute 20 hours to charity hospitals pro bono and the rest time charge whatever the market will bear in their private practices. As it once was.

Jan. 03 2014 10:28 AM
Amy from Manhattan

A recent NPR story on medical pricing gave the example of having a cut stitched costing something like $3,000. How does this fit in w/the reimbursement rates & other factors that have been mentioned?

Jan. 03 2014 10:26 AM
lisa from NYC

Folks, this is ridiculous! The problem is not (just) that doctors won't accept Medicaid! The problem is that, at age 55, Medicaid becomes a loan, not insurance! You have to pay back 100% of the bills, and they put a lien on your assets to ensure that you do.

People seem to think this is a non-issue, because it is happening to someone else. But you would be screaming to high heaven if it were happening to you!

Jan. 03 2014 10:26 AM
lisa from NYC

Becky, how is that true? Because I am ill and age 55, the act bars me from receiving coverage. (Because Medicaid, which requires you to pay back 100% of your medical bills -- not premiums -- at age 55, cannot be called "coverage".)

Jan. 03 2014 10:21 AM

American doctors make so much more than doctors in other countries (for a variety of reasons). Taking the fee doctors receive from insurance here as given and treating the Medicaid reimbursement rate as substandard doesn't seem quite right. If doctors' wages weren't protected by so many policies, the reimbursement rate would fall somewhere in the middle.

Here are some of the policies, since I brought it up. Immigration rules keep more doctors from other countries coming to practice here. Nurse practitioners are prevented from operating independently in many states. Medical schools haven't increased slots in them to keep up with the growth in population.

Jan. 03 2014 10:20 AM
The Truth from Becky

It is a good thing that the less fortunate can now qualify and receive proper humane medical attention. Why would this lessen the quality of care a physician would provide? They are still bound by the hippocratic oath yes?

Jan. 03 2014 10:18 AM
lisa from NYC

RJ, why should I give the ACA a chance? It has cut me off from insurance, just when I need it. As far as I can tell, the purpose of the act is to take insurance away from some people and give it to others. Before, I never had any trouble getting affordable insurance (and in NY, I never had to worry about pre-existing conditions). Now, I can't get anything that doesn't require me to foot 100% of the bills (i.e., Medicaid).

Jan. 03 2014 10:18 AM
Susan from Upper West Side

TThe Surgeon General's Call to Action to Support Breastfeeding has acknowledged that "International Board Certified Lactation Consultants (IBCLCs) are the only health care professionals certified in lactation care. They have specific clinical expertise and training in the clinical management of complex problems with lactation." And this report also includes the strategy to "provide reimbursement for IBCLCs independent of their having other professional certification or licensure." The Affordable Care Act states that insurance should cover lactation services.

Unfortunately, the one practitioner recognized to provide lactation management services is NOT covered by Medicaid because insurance companies are ignoring the certification of IBCLCs and insisting on licensing which can only be provided by states. Since there are not that many IBCLCs yet, they have no lobbying power to push licensing through the states. So, as an IBCLC, I am reduced to offering reduced service fees for Medicaid clients. I charge $5 for attending my group clinics. Typically I end up mopping up after other well meaning practitioners who don't have the training to provide the specific evidence- and experience-based suggestions with the empathy required for mothers improve their infant feeding. Many MDs will only spend 5-10 minutes on feeding problems and I spend 2-3 hours since newborns take at least 45 minutes to feed and since it is highly unpredictable when they are ready to feed you have to build in the extra time to be there for a full feeding cycle from waking up to falling asleep again.

Jan. 03 2014 10:18 AM
Ann from Manhattan

"Third world Healthcare" I have had Medicaid here in NYC from time to time ( as a free lancer) since 2004... very pleased with the "third world service" IN fact medical care in "the third world" is often pretty good But of course people like artim are too busy trying to look for points to support their agenda which is NO care. Doctors in Greece are getting less than $1000 a month ... the fact is that MD's are in excess over seas .. time to let them in and bring the prices down. $135 per visit when you sit with them for 5 min whilst they simultaneously see 5 other patients sounds like just too much to pay... if other workers are facing a "readjustment" in wages then medical workers have to come in line also. Let's balance this by subsidizing medical school education. I've had enough of these bitter, mean spirited, negative, Faux News types snickering on the sidelines ... as their world view is shoved aside..

Jan. 03 2014 10:17 AM
Amy from Manhattan

How are the Medicaid/Medicare reimbursement rates determined in each state? What goes into the decisions?

Jan. 03 2014 10:15 AM
lyn from NY

I don't know why doctors aren't ALL required to accept some number of Medicaid patients. Lawyers are required to provide free (pro bono) services as part of keeping their license or risk a fine. I think we need the same for doctors. My daughter receives Medicaid - her wonderful neurologist works at a Bronx hospital (Montefiore) and helps us coordinate with all kinds of specialists who take us on basically as charity. She receives excellent care despite being limited to Medicaid.

Jan. 03 2014 10:15 AM
Peg

If we have a doctor shortage, perhaps it's time for the US to open it's doors to international practices. After all, the cost of medical services in the rest of the developed world are about half of the US costs And they deliver better medical outcomes, Maybe we can do better by having a little competition and low cost "know how" from medical doctors from other more economical places on the planet.

Jan. 03 2014 10:12 AM
NER from NJ

Medicaid reimbursements will be increased under the Affordable Care Act: https://www.advisory.com/Research/Physician-Practice-Roundtable/Members/Expert-Insights/Medicaid-payment-increase-for-PCPs

Jan. 03 2014 10:12 AM
RJ from prospect hts

*Please* give the ACA a chance. Why would people going to ERs for years, possibly for generations, attended by people they know, with practices they're familiar with when they are their most vulnerable, **immediately** switch? Especially people who don't know the ludicrous convolutions of the US medical system. *Of course,* like most people--including high-income, self-funded, boutique-medical-care-receiving wealthy--they will continue, for a while, to follow familiar practices when they feel sick. The illnesses that have built up, the consequences of untreated conditions, will not disappear at a snap of the calendar page.

Jan. 03 2014 10:10 AM
lisa from NYC

I'm 55, and a medical problem has reduced my income below 138% of FPL. But I also own my apartment. SO I can't sign up for Medicaid, because the Medicaid liens would eat up its entire value before I hit Medicare age. And so I have not been able to sign up for anything and have had to stop treatment. I used to have fabulous insurance, but it was canceled at the end of the year. This act has left me totally out in the cold, with no insurance, just when I need it most.

Jan. 03 2014 10:10 AM
HudsonDC from Washington, D.C.

Why has no one commented on the point that it takes time to adjust people's habits. Just becasue someone has Medicaid does not mean they have a private physician or are used to going ot the doctor's office as middle class people are used to doing.

Jan. 03 2014 10:09 AM
Martin Chuzzlewit from Manhattan

Obama will now be bringing substandard Third-World level healthcare to a broader segment of the American population, including the middle class.
Wait until they realize the bait and switch here.

I hope you Lefties enjoy the fruits of your efforts, LOL.
"They would rather be equal in their poverty and misery ... than unequal in their opportunity."

Jan. 03 2014 09:17 AM

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