Friday, November 14, 2014

News Flash--Expanding Medicaid Enrollment Costs More Money

This story is both comic and tragic. State governments are now realizing that expanding the number of patients eligible for Medicaid is straining their budgets and the healthcare system. Hello! Obamacare allowed the states to expand their Medicaid eligibility rules to cover more people. Twenty seven states have done so. Now Medicaid covers 68 million people in this country while Medicare covers 53 million. In ten years it is projected Medicaid will be used by 93 million citizens. The Wall Street Journal has an article detailing the outcome of expanding Medicaid in New Mexico, the state with the highest proportion of Medicaid patients in the country.

Who will see all these patients? The primary care physicians who are expected to be the gatekeepers are already straining to keep up. Many have capped the number of Medicaid patients they will see in their practice. Dr. Holly Abernethy, a family practitioner in New Mexico, has to keep her Medicaid patients to less than 13% of her practice. Otherwise she will have to work a lot longer to keep her office from closing. As it is, she is making $150,000 per year.

In the meantime patients still need to be seen so they are gravitating to healthcare providers like nurse practioners. Jodi Padgett, an NP in New Mexico, has seen an influx of new Obamacare patients on Medicaid. She will accept up to 40% of her patients being on government insurance. She will be paid the same amount of money seeing a patient from Medicaid as Dr. Abernethy, about $80. Her income this year will be $130,000, almost the same as a medical doctor. But she too will eventually have to turn patients away to keep her business from bankruptcy.

Patients finally turn to the emergency room for their care when they run out of options. At a San Juan Regional Medical Center, ER usage is up about 9%. However, Obamacare cut back compensation to hospitals for uncompensated care, reasoning that more patients will have health insurance. This has decreased the government funding from $12 million to only $2 million. As a result, the local government has had to trim other programs like the local park and raise taxes.

The first hints of the consequences of Obamacare are now starting to trickle in. So far it doesn't look good. More patients have insurance but access to medical doctors may be limited. They may have to settle for being seen by nurse practitioners or physicians assistants. Hospitals are getting flooded by poorly paying patients while their funding gets chopped. Local governments have to raise taxes to make up for the lost revenue. And this is while the federal government is paying for 100% of the extra Medicaid expenses. What will happen in two years when the states will have to start paying for a portion of the Obamacare bill?

It's no wonder nearly half the states' governors have opted out of expanding Medicaid despite the federal government's enticement of 100% reimbursement. The crap is starting to hit the fan. Let these other states get splattered first with the excrement and see how they clean it up.

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