The Trials of Progress in the Affordable Care Act

May 21, 2013
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Five months after primary care doctors who treat Medicaid patients were supposed get a big pay raise, most physicians have yet to see it.

While Medicaid fees vary by state, they are generally far below those paid by Medicare and private plans. The change means an average 73 percent average pay increase nationally, according to a 2012 study by the Kaiser Family Foundation (Kaiser Health News is an editorially independent program of the foundation.)

Five months after primary care doctors who treat Medicaid patients were supposed get a big pay raise, most physicians have yet to see it.

While Medicaid fees vary by state, they are generally far below those paid by Medicare and private plans. The change means an average 73 percent average pay increase nationally, according to a 2012 study by the Kaiser Family Foundation (Kaiser Health News is an editorially independent program of the foundation.)

One of the main tenets of the ACA is the assimilation by Medicaid of the eligible uninsured.  In order to attract more physicians who will accept Medicaid CMS, the states have promised to increase reimbursements for physicians who accept Medicaid.

Affordable care act

Stephen Zuckerman, senior fellow at the Urban Institute, said doctors were hesitant to sign on as a result of the pay raise, given that it expires at the end of 2014, and the implementation problems won’t help. “Because of the temporary nature of the pay raise, it was always questionable how many doctors would jump at treating Medicaid patients if they had not done in the past,” he said. “If doctors were tentative before, they still have a reason to be.”

The federal government’s offer to fund the increase for the first several years leave a very real open question as to how state’s will fund it when the federal subsidy ends.

It does not look promising even before the ACA’s January 2104 timetable kicks in with this delay.  The ACA requires the reimbursement increase for Medicaid in 2014.

Is this a portender to the financial squeezes of the ACA?  The Affordable Care Act only mandates the reimbursement rate if the physician attests to being a primary care provider. Earlier this year, CMS said doctors will be able to get the higher fees retroactively to Jan. 1, when states do implement the provision. But many states have set deadlines for April and May for doctors to self-attest that they are primary care physicians in order to get the retroactive pay. Those that miss the deadline will only receive the pay raise once they fill out a form showing they are licensed as a family doctor, pediatrician or internist.  (Many OB/GYN MDs offer primary care as well.)

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