The Real Deal: How the Healthcare Reform can Impact Medicaid Patients

President Barack Obama signed the Patient Protection & Affordable Health Care Act or HR 3590 (PPACA) on March 23, 2010.  During his speech, he claimed that he was taking America in the right direction, but of course there will always be two sides to the story.  There will be those who will agree that this is a move to help the citizens of the United States, and there will be those who will disagree with the fact.

In summary, PPACA will prohibit insurance companies from rejecting clients based on pre-existing conditions.  This act will also expand Medicaid eligibility for those who are not yet under the program.  Moreover, it will award incentives for those businesses that will provide healthcare benefits to their employees.  Health Insurance exchanges will also be present so that people will have more access to affordable health insurance.

Expanding Medicaid eligibility would mean subsidizing healthcare for those people who cannot afford to insure themselves.  Those under this category are the unemployed, the self-employed, or those that work for insurance companies who do not have health insurance benefits.  Healthcare would now be mandated by the government, and everyone will have access to the health insurance exchanges where they can ‘shop’ for affordable health insurance.

18 million people will be enrolling for Medicaid in the year 2013, Centers for Medicare and Medicaid Services (CMS) Richard Foster estimates.  The dramatic expansion will definitely cause a myriad of problems, with emphasis on the quality of health care.

There will be a dramatic increase in numbers, but not an increase in federal funding. A flood of patients will begin to consult doctors: most of them have chronic conditions, and who may have only sporadically seen a doctor.  These are people who come from disadvantaged and poor families.  Managed care systems are present, but they lose millions of dollars since the state itself was not able to meet all of the costs associated with Medicaid programs that they may have launched.  Even with extensive investments in primary care, and disease management programs, the cost of the rising amount of patients who seek health services do not match the state funding available for the program to use.  The numbers are overwhelming the capacity of healthcare providers to give quality healthcare to these patients.  While it may be true that what is needed is to increase the budge for each state to address these problems, it would cause the federal government an excruciating amount of money.  This was even more aggravated by decreasing the poverty level so that more people can be eligible for Medicaid.  In truth, yearly, the cost for Medicaid rises and this remains unsustained by the government.

Another hard truth is that currently, providers are already rejecting Medicaid patients because of low payment rates.  PPACA requires states to raise the physician rates by using federal dollars.  However, the costs are just too much for the citizens to begin computing.  Perhaps reducing physician’s rates are also to be able to control the state’s budget, but mandating Medicaid expansion would now mean that any other measures to control the cost will be put to waste.  Reimbursement rates may also be affected in this regard.

The bottom line is that Medicaid is a program that aims to help the American citizens.  However, it is not achieving its purpose because of a number of factors, the biggest of which may be the budget.  It is, after all, the main driving force behind programs which states can launch under Medicaid.  I must agree- Medicaid patients are receiving low quality healthcare as it is- and expansion without sustainability will mean low quality service as well.


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