Forced Expansion

Here is an article in the American Medical News talking about how Oklahoma is dealing with whether to expand Medicaid or not.    As you know, this was part of the ACA but left up to the states after the Supreme Court decision.  Here are some high points that I gleaned from the piece:

  • With the work force already stretched to the limits, physicians barely are able to see the patients they have now
  • It’s possible that the states may look to offset these greater shares in the expansion by reducing physician payment
  • Expanding Medicaid could shift working adults and their families from private to public coverage, thus “crowding out” private insurance options in the state

How about the fact that hardly any doctors see Medicaid patients because they pay pennies on the dollar?  These dilemmas will be commonplace soon but the biggest one, in my opinion, will be the threat to doctors.  Here is my Nostradougus prediction:  Doctors, in order to keep their medical licenses, will be forced to accept and see Medicaid patients.  You heard it here first.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  5 comments for “Forced Expansion

  1. Marco
    November 17, 2012 at 11:59 pm

    Once fully implemented in 2014 it will be the Complete Affordable Care Act, or CACA.

  2. November 12, 2012 at 10:57 am

    there is case law to support this already, namely in illinois. and, there can really be only one logical conclusion to the unfunded mandates and such from the top. our new policy will go something like this: “You will be seeing 50% medicaid….and if you don’t like it, to bad. You can move somewhere else….”

  3. Pat
    November 10, 2012 at 1:33 pm

    PS – for the “let’s think out of the box” crowd, here’s a suggestion: To improve physician willingness to see Medicaid, allow…
    (1) Sovereign immunity for all Medicaid encounters.
    (2) Allow the doc to write off the difference between Medicaid rates and competing insurance (this latter is time-limited, because a’ la Medicare, private insurance will continue to ‘cheap down’ to gov’t rates, until we are all eventually on the government plan).

    Of course, this obviously won’t happen, just calling the bluffs out there.

  4. Pat
    November 10, 2012 at 12:30 pm

    Doug, I have been predicting this for years. This may at first be done at the state level, but ultimately I think the Feds will pressure the states. I remember hating the move my Transportation Sec’y Elizabeth Dole in 1984, requiring all the states to up the drinking age to 18 or lose their highway funds (“but hey, you individual states are in charge of your own laws”)

    Remember a few years ago, doctors in Pennsylvania threatened a state-wide strike to protest high malpractice rates/risks (excepting the ER’s and on-call docs) and the governor was even then threatening criminal charges. No one is free anymore relative to the popular will, and the physician less so.

    There is nothing to stop the federal gov’t -especially now, and from now on – to muscle any non-compliant state into requiring their docs to take Medicaid as a condition of licensure.

    And then the guerrilla warfare… in that setting I would proudly advertise that sure I take Medicaid; and I would schedule all my Medicaid patients between 3:330 and 4:00 on Thursdays. Can’t get in to see me? Too damn bad, go to the ER, I don’t care. Eventually the state will audit, probe, and meddle, and backed by whatever lapdog medical society, will require that a certain number of visits, or certain percentage of appointments be Medicaid dedicated, and I would try to pivot and hide some more…the cycle would end with me quitting and going to the ER, if I had not already done so. And I don’t care anymore how many folks on the dole show up there – just keep me paid on time, while it all burns.

    • william brown
      November 12, 2012 at 7:46 pm

      Doug,
      Well, why don’t all those downtrodden docs go on strike. I’m sure the AMA didn’t protest too loudly when the air traffic controllers went on strike for more pay and less stressful working conditions. They could make a very good case, too, but President Reagan fired them anyway. I guess that’s why our airlines are run so better now, and passengers are treated so well. SIGH, so many complaints and so very few solutions.

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