House Republicans have proposed sweeping changes to healthcare policies – including major Medicaid cuts — and five physicians joined Beckers to discuss their thoughts on the policy changes.
Editor's note: These responses are edited lightly for clarity and length.
Question: Medicaid is under scrutiny as Republican lawmakers eye big healthcare budget cuts for this year. How could this affect your practice and/or healthcare as a whole?
John Corsetti, MD. Orthopedic Surgeon at New England Orthopedic Surgeons (Springfield, Mass.): The viability of private practice orthopedic surgery is being jeopardized by the relentless reimbursement cuts, which have persisted in the face of unprecedented post pandemic overhead increases, largely due to labor and supply cost increases. Many practices have become unviable over the last five years as we see an accelerating migration to either employed model or private equity acquisition. Practices are increasingly relying on ancillary revenue, rather than revenue from delivery of orthopedic services, to remain viable. It's become a race to the bottom as practices struggle to ramp up volume to offset reimbursement declines. Unfortunately, in many parts of the country, the viability breaking point is rapidly approaching.
Gregory Lekovic, MD. Neurosurgeon in Los Angeles: In my opinion, Medi-Cal, as Medicaid is known in California, is already dysfunctional. Medicaid expansion has led to broad — but very thin — coverage of a huge swathe of the population. Reimbursements are so low and networks so narrow that coverage other than for basic primary care is already more aspirational than practical. Patients requiring specialty care — for brain cancer for example — commonly have surgery through the ER but cannot get follow-up oncological care in a timely fashion. I have unfortunately had to re-operate on many patients who present months after their initial surgery with regrowth of their brain cancer because their oncologist appointment is still pending authorization. It's very discouraging. Ultimately, cutting Medicaid dollars might make this situation worse; alternatively if Medicaid expansion in particular was curtailed I would hope there would be enough money to provide greater depth of coverage for those remaining on Medi-Cal.
Sheldon Taub, MD. Gastroenterologist at Jupiter (Fla.) Medical Center: I am very concerned about big healthcare budget cuts for patients and physicians. This may require states to tighten eligibility requirements, making it more difficult for Medicaid and Medicare patients to receive the appropriate care. Certain services, such as mental health services, prescription and drug coverage, and vision and dental care may be compromised. Furthermore, reimbursement rates to doctors and hospitals may be cut, causing fewer providers accepting these patients. For the providers who do accept these patients, there will be longer waiting times for patients and access to medical care will be compromised. Higher out-of-pocket copayments may make health care less affordable to low income individuals. With less access to medical care, this may cause more people to rely on emergency room care. This will cause overcrowding of emergency rooms and higher cost for hospitals. Physicians have already seen a 26% cut in Medicare since [the] early 2000s. How much more can they handle?
Thomas Wascher, MD. Neurospine Center of Wisconsin (Appleton): My suggestion would include some way for Medicaid patients to "have some skin in the game." I would suggest that Medicaid patients pay a yearly withhold based on their financial status. Each year, the patient would receive a list of healthcare goals from their family practitioner or internal medicine physician to optimize their health (For example, stopping tobacco use, achieving a reasonable weight, lowering their hemoglobin A1c, taking their blood pressure medication, et cetera) At the end of this period, if the Medicaid patient has accomplished these goals, they would receive their withhold back based on the number of goals accomplished. If not, the withhold would be applied to the care provided for indigent patients. The withhold payment would be available to earn interest at a reasonable predetermined rate. It is time we all take some responsibility for improving the healthcare of our nation while doing whatever is possible to limit increasing costs. I am frustrated with the attitude that somehow these goals end up being the sole responsibility of America's physicians.
Frank Vrionis, MD. Neurosurgeon at Baptist Health South Florida (Boca Raton): Medicaid is a low-income health insurance umbrella funded two-thirds by the federal government and one-third by the states. The average income for Medicaid eligibility is approximately $25,000 for a family of three. Average health insurance cost for [a] nonelderly family of three ranges between $15,000 and $20,000 a year. Therefore, if we do the math, without Medicaid, most low-income citizens cannot afford private healthcare and, thus, become uninsured. The proposed cut of one-third of Medicaid's federal budget currently proposed by the legislation is a draconian cut that will affect low-income patients who have been especially affected by inflation and increased cost of living. These patients will seek expensive and inefficient care through emergency rooms, further straining hospital budgets and physician practices. Although most people feel that Medicaid needs an overhaul, slashing its budget by trillions without providing an alternative may be "bad medicine."