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Medicaid Increase for Doctors Shouldn’t Be on Chopping Block

The list of possible Medicaid cuts in an agreement to avert the “fiscal cliff” includes rolling back a scheduled payment increase for primary care providers.  That’s a bad idea, and it would undercut efforts to ensure that beneficiaries — including the people who become eligible for Medicaid under health reform’s expansion of the program — have access to health care.

As we’ve explained, health reform allows states to expand Medicaid to cover low-income adults with incomes up to 133 percent of the poverty line, with the federal government paying nearly all of the cost.  A new study by Urban Institute researchers finds that large numbers of people will enroll in Medicaid in 2014 even in states that don’t take up the expansion, because other elements of health reform will simplify enrollment and improve outreach.

To draw new providers into Medicaid and encourage existing Medicaid providers to see more Medicaid patients, health reform raises Medicaid’s payment rates to at least Medicare levels in 2013 and 2014 for primary care physicians providing certain services.  The federal government will pay 100 percent of the cost, which would apply to all states, regardless of whether they expand Medicaid.

This boost will help ensure that there are enough primary care providers to serve current Medicaid beneficiaries as well as the people who newly enroll.

The payment increase will “lead to better quality of care for patients and decreased costs for state governments” by helping beneficiaries get cost-effective coordinated and preventive care services through their primary care physicians, according to a recent letter to congressional leaders from over 100 physician groups — including the American Academy of Pediatrics, a leading advocate for children’s health.

Cancelling the increase, in contrast, would create obstacles both for those seeking health care and for those providing it.