Study: It’s Harder to Get Medical Care If You’re a Kid on Medicaid in Chicago
Yesterday the New England Journal of Medicine published a study entitled "Auditing Access to Specialty Care for Children with Public Insurance." While it's well established that families on public medical programs face many theoretical barriers to receiving medical care—language, literacy, and so forth—the purpose of the study was to eliminate all but one question: how hard is it to get in the door if you're on Medicaid or CHIP, even if you have all your ducks in a row: "research on children's access to specialty care has not adequately distinguished between provider-related barriers and patient-related ones."
The answer? It's harder, at least in Cook County. The authors' assistants got more rejections when posing as mothers paying with Medicaid/CHIP rather than private insurance:
66% (179) of the callers reporting Medicaid–CHIP coverage were denied an appointment for specialty care, as compared with 11% (29) of the callers reporting Blue Cross Blue Shield insurance.... When calls to the same clinic were analyzed as matched pairs, there were 5 discordant pairs (2%) in which children with Medicaid–CHIP obtained an appointment but those with private insurance did not, and 155 discordant pairs (57%) in which the clinic accepted privately insured children but not Medicaid–CHIP enrollees....
And when they were able to get an appointment, the wait was longer:
On average, children with public insurance waited 42 days for an appointment with a specialist, whereas privately insured children waited 20 days....
This may not come as a surprise to you. It certainly didn't to the director of specialty medical care at Stroger Hospital, who told the New York Times: "It’s interesting to think you even need a study to prove that. It’s pretty much common knowledge." The Times also notes that it's even harder to gain access in the less densely served suburbs, a problem given current demographic trends.
But it's not just a medical issue; it's a significant budget issue. Medicaid reimbursement—both rates and promptness—has long been a problem in the state. Medicaid reimbursement lags well behind Medicare reimbursement in Illinois. As Illinois Statehouse News reported last month:
The Illinois House Human Services Appropriations Committee is proposing a $463 million payment reduction of Medicaid to hospitals for next year’s budget. But the Illinois Hospital Association is offering an alternative – why not delay reimbursement payments than making deeper cuts?
If you cut, you have to provide less care. If you delay payments, you have to borrow. What sort of costs does borrowing entail?
Quinn, as is his pattern, is talking more about the nifty things he could do with $2 billion than about the huge interest payments that already choke spending on Illinoisans' priorities. He wants this "emergency," short-term borrowing to pay some Medicaid bills before July 1, when the federal reimbursement rate will drop. Borrow and pay now, Quinn says, and Illinois will recapture $175 million it otherwise won't receive. Trouble is, paying the expected 6 percent annual interest — remember interest? — on this $2 billion would deeply diminish that $175 million payoff — and would divert still more budget money to bondholders.
Meanwhile, on the national level, it's starting to look like Medicaid might be the "sacrificial lamb," in Jay Rockefeller's words, in the fight over the debt limit and the related budget cuts. Ezra Klein argues that the best compromise is to spend more on public medical assistance upfront to prevent greater emergency costs, and better management for "dual-eligible" patients—the very sickest and poorest patients. It's clear that's not happening: federal government funding is dropping, which threatens to delay or reduce doctor reimbursement on the state level even further, and the delays and denials ultimately get passed on to the patients.
Photograph: -Tripp- (CC by 2.0)
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Why has no one yet come to the conclusion to have Medicaid carriers be responsible for some of their costs, especially those unnecessary costs of large emergency room bills when they come all the time for non emergent care? How about a co pay for hospital visits and a reduced co pay for doctor's office visits? Get some of the costs covered by the patient's and families who are using it? I work in an emergency room, pay for health insurance for myself and my 3 small children, am divorced, work full time and still have to come up with co pays if I or one of my children requires an emergency room visit! Most families that have Medicaid are frequently in our ERs for nonsense, non life threatening issues and come often enough for most of the staff to know who they are when they sign in and know what their primary complaint will probably be! They need to have some sort of responsibility to pay for SOMETHING. I am tired of my tax dollars going to pay for degenerates who are bright enough to reproduce yet don't have enough sense to give their children Tylenol or Motrin when they have pain or a fever for less than a day, then ask for a prescription on top of it! This coming from parents and kids who are in designer clothes and shoes and carrying Coach purses, have nails done and a pack of cigarettes on hand, wear gold jewelry and usually stop at vending machine for expensive treats while there for a visit for abdominal pain and vomiting! I on the other hand usually buy my medications in the generic form at dollar stores to be able to afford them. Make parents on Medicaid somewhat liable for there decisions on where to take their children for medical care, give an option on amount they wish to contribute in the form of co pay and get some money in return for all of the outlandish costs in the first place! Then maybe the other medical costs would be able to be reduced in the long run if they are not being constantly abused!!!
Medical Care to Die For
Discrimination of any type, especially in medical care is repulsive. It can mean life and death for everyday Americans and their families. Both government and private health insurance deny access to medical care. Rationing=profit.
I was stricken with paralytic polio at age 6 and know firsthand what happens to entire families, when patients cannot assert their rights. My family had no health insurance. Doctors and hospitals provided the best care at little cost. They told me that they hoped that I would repay them when I grew up by helping others in my situation. I promised to do so and kept my promise, with the help of the best husband in the world. I recall that African American child polio victims were sent to segregated hospitals and provided inferior care.
Kaiser Permanente invented rationing. It’s Rosemary’s HMO baby. President Obama adopted the evil creature, anointed Dr. Ezekiel Emanuel to be its private tutor, and ordered American taxpayers to pay lifetime child support.
Patient advocacy that is free from conflict of interest, self-financed, and transparent is posted on www.hmohardball.com
Jacquelyn Finney MPA