March 08, 2017
Area(s) of Interest: Access to Care Health Care Reform
By: Ruth Haskins, M.D., President of the California Medical Association
Long before President Donald Trump campaigned to fully repeal the Affordable Care Act (ACA), the California Medical Association (CMA) has been fighting for access to health care for all Californians.
CMA, which represents over 43,000 physicians across all modes of practice, believes access depends on affordable, quality coverage and reflects the ability of patients to secure appointments with doctors (promptly) for preventative care and when catastrophic circumstances occur.
On March 6, the U.S. House of Representatives’ Republican leadership, with the support of the White House, unveiled the first draft of the “American Health Care Act” (AHCA) as an answer to their promise to repeal and replace the ACA.
While we’re pleased the bill includes an expansion of Health Savings Accounts (HSAs) and state innovation grants, we’re concerned that the current proposal does nothing to improve access to doctors through payment rate increases or network adequacy requirements. And, if federal Medicaid funding is reduced through a per capita cap or other means, this will result in millions losing health care while shifting the burden to the states and ultimately to doctors who are on the front lines caring for patients.
An analysis by the Congressional Budget Office (CBO) found that the new bill would cause 24 million Americans to lose their health insurance within a decade while providing $600 million in tax cuts to wealthy people and insurance companies. To put that into context, it’s estimated that a health insurance premium for a single 64-year-old who makes $26,500 would jump more than 700 percent (from $1,700 to $14,600).
California has been successful in reducing its uninsured population through expansion of the Medicaid program (known statewide as Medi-Cal). Nearly 14 million people, more than one in every three Californians, are now served through Medi-Cal, including 3 million low-income adults enrolled during the ACA expansion.
In our state’s rural areas, nearly half the population is enrolled in Medi-Cal, and another significant portion is enrolled through the state exchange, Covered California. Despite record low uninsured rates, California still struggles to ensure patients have access to care. Six of nine California regions are experiencing a physician shortage, and California still struggles with some of the lowest Medicaid reimbursement rates in the nation (coming in as low as 40 percent below Medicare rates).
Low reimbursement rates make it hard for doctors to maintain a practice that can serve residents in their communities. This situation keeps patients waiting for needed care, especially in rural and underserved areas that struggle to attract doctors and other medical professionals.
When a pregnant Medi-Cal patient in the Central Valley is found to have an abnormal heart condition, she needs immediate access to a cardiac specialist to protect herself and her child. But of the two cardiologists in her area, one isn’t accepting new Medi-Cal patients, and the other has a three-month waiting list. Her options? Traveling 60 miles or relying on the emergency room for care.
Unfortunately, her dilemma is quite common, and it can only be improved if health reform works toward increasing provider payment rates and investing in robust provider networks so that patients can see a doctor promptly.
Medicaid and Medicare spending is increasing nationwide because our population is aging and facing multiple chronic conditions. The per capita cap proposal, as currently written, ensures that Medicaid physician payment rates will never keep pace with rising costs, particularly with our more vulnerable patient populations that face complex and costly medical conditions.
The AHCA could also force states to reduce eligibility and benefits. These cuts will simply not improve access to care. Early warning signs for diseases like cancer or diabetes are easy to spot when patients are consistent with preventative care, but they can become deadly if patients aren’t able to access regular check-ups and appointments.
Studies show that reductions in Medi-Cal will result in patients foregoing needed medical care, seeking episodic care in costly emergency rooms, and eventually suffering from more serious and advanced illnesses that could have been prevented. Even if federal Medicaid funding remains the same until 2020, states like California that expanded coverage for very vulnerable individuals will face a difficult choice: cut services or unbalance the budget.
We appreciate that this draft of the AHCA is still the starting point in the conversation, but Medicaid funding must be protected and increased to care for America’s most vulnerable populations, and more work must be done to deliver access to doctors and affordable, quality care.
CMA remains committed to working with Congress and the Trump Administration to develop a final plan that ensures patients can access doctors to receive high-quality and affordable health care.
Dr. Haskins is an OB-GYN practicing out of Folsom, Calif., and has been a CMA and Sierra Sacramento Valley Medical Society member for 24 years. She served on the CMA Board of Trustees from 2013–15 and as chair of the CMA Council on Legislation from 2010–13.
EDITOR’S NOTE: It’s important that Congress makes changes to the legislation to improve access to doctors, ensure that currently covered Californians do not lose coverage, and guarantee that insurance is affordable and meaningful. Urge Congress to protect patients’ access to quality care today!