Note to readers—please read the post below, “Pulse—More Stories from the Heart of Medicine” (which includes “One More Child Left Behind”) before you read this post.
When I read “One More Child Left Behind,” all I could think of was how much Aaron’s arm must have hurt during the more than 24 hours that he didn’t receive treatment. I also imagined how frightened and bewildered the six-year-old must have been as he heard his mother and grandmother talk, and realized that they couldn’t persuade a doctor to help him.
This story was published in 2009—one year before the Affordable Care Act was passed. The ACA extends Medicaid to millions. But even under reform legislation, many children like Aaron will not receive care. This is because Medicaid now pays an average of 34% less than Medicare for exactly the same treatment.
Why on earth would we pay doctors and hospital less to care for poor patients than we would pay them to care for the elderly?
Lower Medicaid fees are part of the legacy of racism. (I write about this in Money-Driven Medicine.) When the Medicare and Medicaid laws were passed in 1965, Southern Congressmen refused to agree to laws that would pay doctors who treated the poor as much as they reimburse physicians who care for older patients.
At the time, relatively few African-Americans living in the South were over 65. Most died long before they would be eligible for Medicare. Yet many African-Americans were poor, and would qualify for Medicaid. This is what disturbed Southern legislators. They wanted to make sure that healthcare remained segregated.
Even under Reform, Specialists Who Treat the Poor Will be Under-Paid
Medicaid rates vary widely by state, but on average, according to the Kaiser Family Foundation, the new program will offer PCP’s a 73 percent raise This should open doors for millions of Medicaid patients. In some states that have been paying the lowest rates, the hike will be much higher. (See this map) The ACA guarantees raising Medicaid reimbursements for primary care for just two years (2013-2014). But I expect this program will be extended, although increases may be modified. Once begun, it will be very hard to justify ending it.
At the same time, specialists who care for Medicaid patients will continue to receive about 1/3 less than when treating seniors. As a result, even under the ACA a great many Medicaid patients will be hard-pressed to find a specialist willing to see them.