Doctors would rather have something than nothing

When I was testifying yesterday, one of the questions asked of me relayed a feeling that most doctors and hospitals would oppose the Medicaid expansion. Um, no.

Look, I don’t doubt there are individual doctors who do. I know some. But pretty much all of them see few Medicaid patients, have lucrative practices, and are more politically opposed to the ACA than the average person. But they don’t speak for the health care system as a whole.

Take Indiana, for instance. The Indiana Hospital Association supports the expansion, for pretty much the same reasons I do. As do many (if not all) of the physician groups that represent people more often covered by Medicaid.

There’s a reason for that, and it’s not necessarily altruism.

What many seem to miss, over and over, is that we’re not debating between giving the uninsured Medicaid or private insurance. We’re debating between giving them Medicaid or nothing.

Many of the doctors who hate Medicaid don’t like that it under-reimburses. They get much more money from private insurance. So they preferentially choose privately insured patients, and they avoid Medicaid patients. That’s their right.

But some types of physicians don’t have that option. About one third of kids are covered by Medicaid, as are one third of births. So pediatricians see a disproportionately large number of Medicaid patients, as do OB-gyns. Medicaid generally doesn’t cover non-elderly adults well. So general internists and family physicians see a large proportion of the uninsured.

Ask these groups if they’d like to see Medicaid expanded, and they will say yes.

Why? Well, a GP who sees an uninsured patient, and likely receives nothing for caring for them, would rather get a Medicaid payment, even if it’s not as much as it would be from private insurance. Something is better than nothing. The same goes for hospitals that care for the uninsured or under-insured. They would all rather get “measly” Medicaid dollars than get nothing at all.

Most of the physicians who oppose the Medicaid expansion would rather see privately insured patients than Medicaid patients. That’s their right. But lots of physicians, and most hospitals, don’t have that luxury. They’re choosing between uninsured patients and Medicaid patients. Some payment is better than none.*

*Let’s not forget that all of this ignores the health benefits of the Medicaid expansion, the economic benefits of the expansion, and the fact that the ACA is significantly increasing Medicaid reimbursement for a while.


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