The New Health Dialogue

In her post earlier this week about the debate about the future of the State Children's Health Insurance Program under health reform, Allison Levy mentioned the challenge of low Medicaid payment rates to doctors -- so low that many doctors won't take Medicaid payments. So while Medicaid on paper has a better benefit package than SCHIP, it's hard for low-income people to get those benefits if they don't have a doctor willing to take Medicaid patients. We posted a few months ago, too, about the length of time Medicaid patients have to wait to see a doctor in various U.S. cities. Both the Senate and House bills would boost payments for primary care in Medicare, but only the House raises them for Medicaid as well. Jonathan Cohn wrote a good column on that this week (it's at TNR and at Kaiser Health News.) Cohn noted that a) programs for very poor people don't have strong constituencies and b) it costs a lot to fix the Medicaid payments, about $57 billion over 10 years according to CBO. Still he said, the Senate centrists like Ben Nelson of Nebraska and Joe Lieberman of Connecticut who don't want to boost the cost of health reform should still embrace this idea, he argued.

Higher Medicaid reimbursements ought to be the sort of change that the Liebermans and Nelsons of the world support, at least in theory. Remember, they opposed creating a stand-alone public insurance option for non-elderly Americans precisely because they feared it wouldn’t pay providers well enough. Increasing the reimbursements in an existing public insurance program that already underpays doctors and hospitals would seem like a no-brainer -- which, as it happens, it is, for a great many reasons.

He didn't get into the reasons -- but remember that a lot of the overcrowding in emergency rooms isn't just the uninsured. It's also Medicaid patients -- patients who don't have easy access to a primary care physician, so they end up in the E.R. where care costs more. They may also be sicker -- access to good primary care can prevent some diseases,  detect others before they get so serious, and control and monitor chronic diseases so patients don't need as much hospital care.