Physicians: Stop Medical Emergency for Medicare/Medicaid Patients
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TMA President-elect Stephen Brotherton, MD, joins the Border Health
Caucus and physicians from around Texas calling for reversal of the dual-eligible cut. |
Dozens of
physicians from across Texas took time away from their medical practices to ask
state leaders to reinstate cuts that harm access to care for thousands of
Texas’ dual-eligible
patients. Dual-eligible patients are old enough to qualify for Medicare and
able to qualify for Medicaid assistance because of their income.
Texas Medicaid
slashed program funds over a year ago at the direction of the 2011 Texas
Legislature, creating a medical emergency for thousands of
dual-eligible patients and the doctors who care for them.
“The increased
regulation and low Medicaid payments are forcing doctors to leave the Valley or
retire early,” said Victor Gonzalez, MD, Hidalgo-Starr County Medical Society
president, and member of the Texas Medical Association (TMA) and Border Health
Caucus (BHC). “It’s impossible to recruit young physicians.” The
ophthalmologist lost six young physicians he trained and who received retina
fellowships under his program. Dr. Gonzalez explains, “When the health care
infrastructure collapses, it hurts all patients in the community and in
neighboring cities. If patients can’t get care in a Harlingen emergency
department (ED), they will end up in a San Antonio, Houston, or Dallas ED at a
much greater expense.”
For nearly a
year, TMA and BHC physicians organized rallies, met with state leaders, and lobbied to get
the cuts reversed. BHC is a confederation of county medical societies that work
together to improve patient care and public health throughout South Texas. Many of the BHC doctors take care of large percentages
of elderly, low-income patients.
“Texas must fully
reinstate the Medicaid cuts to ensure dual-eligible patients receive the health
care they need to survive,” said Stephen L. Brotherton, MD, TMA’s
president-elect. “We must take another step to stop Texas’ medical emergency
that’s harming access to care for thousands of patients and their doctors.”
Background
Medicare and
Medicaid pay dual-eligible patients’ medical bills, with Medicare paying a majority of the tab. In January 2012, Texas Medicaid stopped paying the
patients’ Medicare deductible, which was $140 — this year its $147. Medicaid
also stopped paying the patient’s coinsurance (due if Medicare’s payment to the
physician exceeded what Medicaid pays for the same service, which is usually
the case). The coinsurance had been an 80/20 split, with Medicare paying 80
percent of the patient’s doctor bill and in most cases, Medicaid paying the
remaining 20 percent.
These cuts
affected approximately 320,000 dual-eligible patients in Texas, who are the
oldest, sickest and most frail, and who rely on regular physician care and
prescription medications. Doctors kept seeing these patients even though Texas
Medicaid was not paying the patients’ deductibles nor fully paying all of the
20-percent coinsurance. Many doctors were forced to tap savings, obtain loans,
cut staff, retire early, or move away. Some patients lost their doctor
altogether.
Other patients
were more fortunate, like the 5,000 dual-eligible patients of Javier A. Saenz,
MD, a family doctor in La Joya, Texas. “For months early last year he worked 12
hours every day, caring for his patients’ needs the best he could, while the
State of Texas paid him basically nothing for providing all of that care,” said
Dr. Gonzalez. “He exhausted his personal savings account of $50,000 and took out
bank loans so he could keep his doors open and continue to care for the people
of his community.”
Part of
the Cut Restored
Finally
last week, under the direction of the Texas Legislative Budget Board, the Texas
Health and Human Services Commission restored coverage of the Medicare
deductible for dual-eligible patients in 2013.
“That’s a start,”
said Dr. Brotherton, pleased that some relief has arrived. But the 20-percent
coinsurance cut remains.
“We’re asking
state leaders and lawmakers to fully restore the funding for our
Medicaid-Medicare dual-eligible patients,” said Luis M. Benavides, MD, the
Border Health Caucus vice chair. “Our patients need us.”