It has yet to be seen whether Nebraska will expand Medicaid under the new federal health care law, but one state lawmaker wants to make sure medical professionals do not discriminate against Medicaid patients.
Some doctors already don't accept Medicaid patients because its reimbursement rates are lower than private insurance and Medicare, the government program for the elderly. In addition, filing Medicaid claims is a labor-intensive process.
About 32 million uninsured Americans will get health care coverage under the new law. And it is estimated that 20 million of those will be insured under Medicaid, the federal-state insurance program for the poor.
"We're inviting a lot of people to a party ... a Medicaid coverage party. And they are going to show up and not be able to get in the door," said Sen. Mike Gloor of Grand Island.
The federal Affordable Care Act gives the option to states to expand Medicaid. Gov. Dave Heineman has said repeatedly he is against the expansion, which would give Medicaid coverage to 54,000 uninsured Nebraskans. He says expanding Medicaid would take money from other areas, such as education.
On Wednesday, the Legislature's Health and Human Services Committee discussed Gloor's bill (LB338), which would amend state law for credentialing and licensing health care providers to prohibit discrimination against people covered by Medicaid. The bill would allow a medical facility or health care professional to be disciplined if they are found to be doing so.
"We get excited about expanding Medicaid, but right now, it's hard for Medicaid patients to be seen" by a health care professional, Gloor said.
Gloor said providers would not be required to take all Medicaid patients seeking care, only their "fair share." How that would be calculated remains to be seen.
The federal government has raised Medicaid payments for primary care to match those paid by Medicare, but the increases are only for two years.
The bill was opposed by the Nebraska Medical Association.
Kerrey Winterer, CEO of the Nebraska Department of Health and Human Services, was among those supporting the bill.
"Medicaid can be a challenge, especially for primary care physicians who often don't get reimbursed sufficiently to cover office expenses let alone cover additional Medicaid requirements," said Nebraska Medical Association representative Ann Frohman.
"Additional Medicaid expenses can take many forms. For instance, the Medicaid population includes many non-English-speaking individuals. Physicians must provide interpreters at their own expense under Medicaid, which can be hundreds of dollars per office visit."
The bill also was opposed by the Nebraska Hospital Association.
"Given the relatively poor reimbursement rates for Medicaid providers, Nebraska is facing a growing shortage of primary care providers," said Bruce Rieker, an association vice president. Without an adequate supply of primary care physicians, the state cannot guarantee timely access to care, creating a gap between coverage and actual provision of services.
"LB338 would force all health care providers to accept all such patients at such rates determined by the state," Rieker said. "Forcing providers to accept lower reimbursement rates as a condition of licensure would effectively make them employees of the state. As providers and policymakers push for more preventive care, it is ironic that a well-intended proposal such as LB338 could drive up health care costs by pushing more patients toward the hospital emergency room for their primary care because primary care physicians and specialists may opt to practice in another state."
Rieker suggested rolling Gloor's bill into a resolution (LR22) by Sen. Kathy Campbell of Lincoln that would create a panel to bring together policymakers, public and private insurers, health care delivery organizations, employers, consumer groups and others to work toward controlling health care costs and improving health care quality.
The recent analysis of the Affordable Care Act showed that 13 percent of Nebraska residents are enrolled in Medicaid. Another 6 percent to 9 percent would enroll with expansion.
Heineman has said the expansion would be too costly for the state and that the federal government, although it says it will pay the full cost for several years and gradually drop to 90 percent, has a history of not keeping its promises on such things.