If Medicaid Expands, Primary Care Providers May Stop Serving Beneficiaries

An article in this week’s edition of the Puget Sound Business Journal (PSBJ) brought to light a fear which many primary care doctors share about Medicaid expansion in Washington: it will equate to more Medicaid patients.

The Washington State Hospital Association states that the rate paid by private insurers for an adult’s typical doctor’s office visit in Washington is $112.20.  The rate paid by Medicaid? $37.84.

That amount hardly covers expenses, leading doctors to increase rates for the privately insured. To address the cost of Medicaid expansion, doctors may now begin denying or limiting Medicaid patients, meaning less access to primary care and more hospital visits. To put that in context, the PSBJ interviewed Dr. Paul Buehrens, a family practitioner in Kirkland:

“I don’t think the leaders in our state Legislature really understand that there’s going to be a huge crisis in primary care access,” he said. “People in my field can decide to accept these patients, but they are going to go out of business.”

The article went on to say:

At Pediatric Associates in Bellevue, CEO Dr. Glenn Lux said he has to limit Medicaid and Medicare patients to about 10 percent to 12 percent of his practice.

“Offices that have more than that,” he said, “go out of business.”

There is talk of increasing Medicaid reimbursement to the same level as Medicare, which pays on average $76.05 for those doctor’s office visits. However, it’s uncertain whether that would be enough to cover costs – not to mention the question of where that additional money would come from.

In the case of a hospital that receives these previously uninsured patients without access to primary care, expanding Medicaid could mean more money. This, because hospitals cannot refuse service to people without insurance, means where an individual once went to a hospital without the ability to pay the bill, Medicaid would now have them covered, and hospitals would be reimbursed.