Happy 50th Birthday, Medicaid & Medicare!


It’s hard to believe that it’s been half of a century since President Lyndon B. Johnson signed Medicaid, along with Medicare, into law. Even though Medicare more commonly provides coverage for a smaller fraction of the patients in a typical ob-gyn practice, it still is an example of a national program that works very well, providing coverage for more than 50 million people. Over the past 50 years, Medicaid has grown to cover more than 71 million Americans — nearly one in ten women relies on Medicaid for health coverage which includes family planning, screening for breast and cervical cancer, and long-term services and support. In fact, Medicaid covered 45% of all U.S. births in 2010 and plays a critical role in ensuring access to pregnancy-related care. Without Medicaid, many women would struggle to access or be unable to afford the care we provide.

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Continuing to Help Low-Income Women Access Primary Care

Medicaid is an integral part of our health care system and a crucial source of coverage for many of our patients. More than one out of every ten adult women in the US (13%) are insured by Medicaid. However, the promise of timely access to care through the program is limited by low reimbursement rates across most of the country.

On average, Medicaid pays a doctor only 59% of what s/he would earn for treating a patient with Medicare for the same primary care services. In some states, payments lower than the cost of care force doctors to limit the number of Medicaid patients that they can see, or not accept Medicaid patients at all.

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Getting Low-Income Women the Primary Care They Need

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. Continue reading

Guest Blog: Navigating ACA, SGR, and Changes in Ob-Gyn Practice

Mark DeFrancesco, MD, MBA

Mark DeFrancesco, MD, MBA

As the Affordable Care Act (ACA) is rolled out, expanded insurance coverage will encourage more women to obtain preventive care. Payment models will shift from “fee for service” to capitated or bundled payments. This applies to both Medicare and government plans, and private insurers who usually follow The Centers for Medicaid & Medicare Services’ (CMS) lead.

With more doctors accepting new Medicare patients and an expected increase in patients with insurance of all types, we must adapt our practices to accommodate them and provide more comprehensive care. This will be easier if you are in a large practice. It might be a large merged practice like mine, perhaps a hospital or health system, or even a “virtual network” of clinically integrated separate practices. We will need to perfect a team approach, no matter what form it takes. We can be much more efficient if we collaborate with other providers, such as certified nurse-midwives and advance practice nurses.

This shift to new practice models has been in the works for years. In 1997, as I saw some of these changes on the horizon, I helped create Women’s Health Connecticut, a statewide ob-gyn private practice. Now with almost 200 ob-gyns and 35 collaborative providers, we are one of the largest single-specialty women’s healthcare groups in the country, and have raised the quality of care given to patients in our state. This model is also developing rapidly in Florida, North Carolina, and many other states.

In addition to developing better practice models, we must solve the physician payment piece of the puzzle. The unfortunate reality is that under the CMS sustainable growth rate (SGR)—a formula originally intended to control physician-related Medicare costs—doctors are not fully reimbursed for the costs of treating patients. If actually applied, the SGR would reduce payments to physicians each year. At this point, if allowed to kick in, the SGR would require a cut exceeding 25% in physician reimbursements. Each year, Congress passes legislation that postpones the cuts. To more definitively deal with the SGR problem, while further containing health care cost increases, Congress is considering a more comprehensive re-design of the payment system.

Because of my experience in growing a profitable new model of practice that delivers improved patient care, ACOG President Dr. Jeanne Conry has asked me to chair ACOG’s SGR Task Force. The task force will help ACOG develop and review legislative proposals to eliminate the SGR and to significantly redesign the payment system in a way that rewards quality and appropriately covers the cost of providing care.

When we keep our practices healthy, we are able to provide better care to our current and future patients. I have no doubt that ACOG will continue to provide guidance and assistance in adapting to the changes in the health care environment, and I am proud to be able to help.

Mark S. DeFrancesco, MD, MBA is an ob-gyn and chief medical officer at Women’s Health Connecticut.

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Guest Blog: Why Expanding Medicaid Matters for Women

Gerald F. Joseph Jr, MD

Many women in the United States do not have health insurance. As a result, they don’t get the health care they need and their health suffers. Compared to women with health insurance, uninsured women are:

* Less likely to receive preventive care or treatment for disease.

* More likely to be diagnosed with cervical and other cancers at a late stage and die from the disease or its complications due to a delay in diagnosis.

* Less likely to get prenatal care during pregnancy. The babies of uninsured women are also more likely to be born with a low birthweight and die within the first year of life.

* Less likely to use a prescription contraceptive, which can lead to unintended pregnancy.

The Affordable Care Act (ACA) can help. It expands Medicaid—the state-federal health insurance program for low-income individuals—which is one of the health care reform provisions that ACOG supports. The percentage of uninsured women ages 19–64 could decrease from 20% to 8%, but this will happen only if all 50 state governors decide to expand their Medicaid programs. ACOG encourages all states to accept this expansion offer, under which the federal government will pay all the costs until 2016. After that, the federal contribution gradually drops, but only to 90% in 2020 and beyond.

The ACA also makes it easier for states to provide Medicaid birth control coverage to low-income women by eliminating bureaucratic red tape.

With Election Day approaching rapidly, I encourage you to find out what the candidates in your state support. Use your vote to make it clear to your state lawmakers that expansion of Medicaid is good for women’s health.

For more information:

Protect Medicaid and Women’s Health

What the Medicaid Eligibility Expansion Means for Women

Medicaid Expansion Resources

Gerald F. Joseph Jr, MD, is ACOG vice president for practice activities.