An undercover investigation in Illinois has revealed that children on Medicaid are often denied healthcare by specialty physicians, while their privately insured peers gain access to the care that they need. The study confirms suspicions that many physicians are not inclined to provide treatment to patients who have public insurance coverage. Details of the investigation can be found in the The New England Journal of Medicine.
Investigative researchers posed as mothers who were seeking treatment of sick children insured by the Illinois Medicaid Children’s Health Insurance Program (CHIP). Alarmingly, nearly 66 percent of the children were denied care by the offices of doctors they approached. However, when claiming to have private Blue Cross and Blue Shield insurance, a mere 10 percent of patients were turned away. Orthopedic specialist and psychiatrists were found to have the greatest likelihood of refusing to see Medicaid patients, at a whopping rate of 80 percent.
In a statement, lead researcher Dr. Karin Rhodes of the University of Pennsylvania said, “We found disturbing disparities in specialty physicians’ willingness to provide outpatient care for children with public insurance—even those with urgent and severe health problems.” Regarding the outcome of the research, Rhodes acknowledged, “This study shows a failure to care for our most vulnerable children.”
For their investigation, the researchers who posed as mothers of ill children phoned a total of 273 specialists in the Cook County, Illinois area to potentially get treatment for children having a variety of medical issues, including serious conditions such as uncontrolled asthma and new-onset seizures. However, it was disheartening to find that even children who suffered from epilepsy had only a 46 percent chance of receiving an appointment with a neurologist.
More than 50 percent of the physician office receptionists requested details of insurance coverage prior to granting an appointment, and some fast-refused an appointment when learning that the child in need of treatment had CHIP coverage. In addition, among those patients on Medicaid who actually succeeded in getting an appointment, appointments were scheduled an average of 22 days later than those for children having private health insurance.
With the continuing debate in Congress over rising health care costs, and the need of many Americans for better access to health insurance, the findings of the research appear to only add insult to injury. Although the recent health reform bill passed by Congress and signed into law by President Obama will supposedly provide about 32 million people with the insurance coverage they so desperately need, a part of the coverage is to be achieved by the expansion of Medicaid. In addition, for others, healthcare assurance is gained by Medicare coverage.
But if physicians are unwilling to treat the multitudes of ill children who are dependent on public healthcare coverage, what will the chances be that countless adults requiring treatment for their ailments will actually receive it?
In a telephone interview, Rhodes noted, “The key take-home message is that every state needs to study its access. Otherwise, the disparities will continue and we’ll be blindsided to that. It’s very ethical to test the system, and I’m saying, ‘Here’s a model to use.’”
Rhodes also pointed out that due to the complexity of Medicaid paperwork, low compensation, and much delayed reimbursements, doctors have little to no incentive to accept patients who are covered by the program. This is especially true among physicians having small private offices.
Whereas the Medicaid CHIP pays an average of $99.36 for a patient consultation, the amount is only a little more than half of the average private insurance payment of $160. Doctor’s offices depend on cash flow to cover the overhead necessary for keeping the doors open to patients, creating a dependency between business success, and the ability of medical science to preserve health and save lives.
If this first state audit of Medicaid performed in Illinois is indicative of grim results that are yet to be confirmed across other states of the nation, it warns of impending doom for Obama care. And with the U.S. government planning to cut federal Medicaid spending and Medicare reimbursements, the foreboding only worsens.
More than $90 billion in special U.S. government funding for Medicaid will come to an end in just a few short weeks if nothing is done by lawmakers to extend the funding. This will cut benefits for millions. In addition, plans are in the works to reduce the amount of reimbursement for services provided by Medicare. These measures will force increases in costs among other areas of the nation’s health-care system, and only add to the number of Medicaid patients who are refused treatment by physicians. In addition, the benefit cutting moves will likely trigger an increase in the refusal of treatment for the scores of patients covered by Medicare.
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