Shortage of Medicaid providers leaves gap for many low-income patients


By Dr. Shane Macaulay

Last June when the Legislature approved the expansion of Medicaid in Washington as part of the Affordable Care Act (ACA), health care advocates across the state celebrated. It was an important part of the ACA's goal of providing healthcare to the one million Washingtonians who had no health insurance.

We know that when people have insurance they get preventive care and better manage chronic conditions like asthma, which improves health outcomes and reduces preventable emergency room visits and overall health care costs.

There is significant demand for expanding Medicaid coverage to more low-income Washingtonians. The Eastside’s increasingly diverse population includes a growing number of people eligible for Medicaid.

But there is a missing piece in this equation: an adequate supply of primary care physicians who accept Medicaid patients. This physician shortage is the result of unfair Medicaid compensation.

Fortunately our Legislature can fix this problem now by extending a temporary increase in Medicaid payment rates that the federal government funded beginning in 2013. The federal government has offered the state money to bump Medicaid rates up to Medicare rates for primary care such as pediatrics and family practice, if the state will provide matching funds.

Without this fix, Medicaid reimbursement rates fall far short of covering physicians’ costs to provide care. For example, Medicaid pays just $39 for an adult routine office follow-up visit, which costs $85 – a $46 loss for the provider. These losses are not sustainable, and many practices must restrict or exclude Medicaid patients to keep the business alive. With the Medicaid payment increase, that same visit is reimbursed at $77. While still an $8 loss, some providers are able to more easily absorb that, and it’s closer to the Medicare rates which are typically about $7 less than the cost to provide the care.

Although as a radiologist the increased rates for primary care won’t directly impact my practice, they greatly affect patient access to care, which ripples out to the whole health care system. Patients who cannot find a primary care physician to see them can wind up in the ER, increasing ER wait times and increasing health care costs and insurance premiums for everyone.

Working with physicians and hospitals, the state saved $33 million in just one year by reducing non-urgent ER use, but the continued success of this program depends on patients being able to receive care from primary care physicians in our community.

Currently 42 per cent of Washington children are served by Medicaid. And with the program’s expansion, a growing number of adults will rely on it, creating increased demand for care across the state. It is estimated that the U.S. will face a shortage of more than 52,000 primary care physicians by 2025.

The federal government’s temporary fix sought to address this shortage by providing fair Medicaid compensation for primary care and preventive health services. But their 100 percent funding covers just two years, through the end of 2014. A $24.8 million investment is needed now from Washington state, which could bring another $57 million in federal matching funds.

The Legislature expanded Medicaid coverage to help our state’s lower-income families. But to turn that promise of coverage into reality they must act now on fair Medicaid compensation to ensure that coverage equates to access to care in King County and across the state.


Dr. Shane Macaulay is an executive officer of the Washington State Medical Association and a radiologist at Center for Diagnostic Imaging, practicing in both Bellevue and Kirkland.

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