The value of the Medicaid program in ensuring care for low income women and families cannot be overstated. Nearly one out of every five woman in the US (19%) is insured by Medicaid. Yet the importance of the Medicaid program is undercut by the current biased payment system.
When treating Medicaid patients, physicians generally receive a lower reimbursement rate than they do for Medicare or private insurance patients. Nationally, Medicaid pays just 73% of Medicare rates for most primary care services. The difference in reimbursement rates means that many physicians can only accept a limited number of Medicaid patients. This makes it hard for low-income patients to find providers and get access to the health care they need, especially primary care, which is so important for improving health and reducing health care costs.
The Affordable Care Act acknowledged the importance of this issue. It created a “pay bump” for family physicians, internists, and pediatricians to Medicare levels when providing certain primary care services to Medicaid patients. However, this pay bump missed the mark by excluding ob-gyns.
Many ob-gyns provide primary care services in their practices. In fact, 60% of ob-gyn Medicaid billing is for primary care services. Well-woman visits and pregnancy check-ups often include primary care services such as vaccinations, diabetes screening, nutrition counseling, family planning, and smoking cessation advice. A woman’s ob-gyn is often the only doctor she sees regularly. And ob-gyns know the importance of preventive care. Healthier women have healthier pregnancies, which lead to healthier babies and families.
In addition, the pay bump was not permanent and it is set to expire this year. That’s why ACOG strongly supports legislation introduced this summer by US Reps. Frank Pallone (D-NJ) and Henry Waxman (D-CA) and Sens. Murray (D-WA) and Brown (D-OH). HR 5364, the Children’s Health Insurance Program (CHIP) Extension and Improvement Act of 2014, extends the pay bump through 2019. S 2694, the Ensuring Access to Primary Care for Women & Children Act, extends it through 2016, and both bills apply it to ob-gyns. Please contact your legislators and ask them to cosponsor the bills today.
With as many as 7 million low income women entering Medicaid due to the recent expansion, demand for services will only increase. This bill would help more low-income patients get the preventive services they need and eliminate inequality in the health care system. In order to best optimize our resources for women’s health, parity in payment is critical.