Doctors struggle to afford Medicaid patients. How can WA solve the problem?

Plus an interesting endorsement for Lands Commissioner, and some sort-of-recommended reading

Washington doctors in private practice are feeling the pinch as the cost of doing business has skyrocketed due to inflation, physician shortages, and lingering economic impacts of the COVID-19 pandemic. The economics of the health care business has forced some practices to close their doors entirely and others to get stricter about what type of health insurance they are willing to accept. 

The people who lose most in this scenario are the roughly 2 million patients in Washington covered by Medicaid.¹ Program eligibility depends largely on income levels and proximity to the federal poverty level. Pregnant women, children, parents, and people with disabilities are also eligible for Medicaid. People older than 65 are covered by Medicare, a separate, more generously funded federal program.  

Patients with Medicaid, or Apple Health as Washington’s program is called, are offered a complete medical benefits package, including prescription drug coverage, at least on paper. In reality, many Medicaid patients struggle to access timely medical care compared to patients with commercial insurance or Medicare. 

Physicians who accept Medicaid lose money because Washington has among the lowest Medicaid reimbursement rates in the nation.² This means Washington doctors who schedule an appointment with a Medicaid patient are paid less by the Medicaid program than if they delivered the same care to a patient with commercial insurance or Medicare.³ 

Dr. Doug Seiler, a radiologist and president of TRA Medical Imaging in Washington, gave a run-down of the numbers to lawmakers back in February. A routine fetal ultrasound at TRA Medical Imaging costs the clinic about $90, factoring in costs, equipment, staffing, etc., he said, not including physician pay. Medicaid reimburses a fetal ultrasound at his clinic at $45, meaning it actually costs the clinic $45 to care for a Medicaid patient. 

Why you should care about this: The low reimbursement rate for Medicaid is a health equity issue. Recent estimates show about 20% of Washington residents used Medicaid/Apple Health to pay for their health care in 2022, according to data from the Kaiser Family Foundation. More than half of Medicaid recipients in Washington identify as Black, Indigenous, and other people of color. Also, Medicaid paid for about 33% of births in Washington in 2022. 

Photo by National Cancer Institute on Unsplash