OPINION: Medicaid Forward would kill private medical practices that serve adults

Expanding insurance for uninsured people by increasing Medicaid eligibility seems like a great idea at first blush. Of course, we want everyone in New Mexico to have access to health care coverage.

However, having a Medicaid card does not mean you have a doctor to see you.

The Medicaid Forward bill being proposed in Santa Fe, House Bill 186, will have detrimental long-term impacts to the entire medical system. This bill makes me very scared about the future of health care in New Mexico, and I encourage every legislator to vote against it.

New Mexico’s medical system is fragile at best. There have been dozens of news stories talking about the problems and delays people have getting in to see a doctor, doctors leaving the state in record numbers, the cost of medical malpractice insurance, and on and on.

A less known story is how hard it is for private medical practices to make ends meet given the reimbursement rates for Medicare, which is the plan that covers about 25% of New Mexicans — people 65 and older.

Medicaid covers about 48% of New Mexicans, primarily mothers and children, even with the expansion. But most specialists primarily see people with chronic diseases like diabetes or cancer, and who are either covered with a traditional commercial health insurance plan or Medicare. Medicare reimbursement rates only pay 80% to 83% of the costs of care for physicians, meaning we typically lose money on every Medicare patient we see.

Specialists rely on the commercial insurance market to make up the gap and cover the expense of seeing a Medicare patient and providing care.

According to a study conducted by Mercer on the proposed Medicaid Forward plan, approximately 7% of people currently insured on a commercial plan will switch over to the Medicaid Forward plan. Losing this money will make practices unable to cover the costs of seeing Medicare or Medicaid patients. Mercer did not calculate the increased costs or decreased access that would result from this bill.

When practices cannot afford to see Medicare and Medicaid patients, their doctors either leave the state, retire or join a hospital. Hospitals are paid twice as much for seeing Medicaid and Medicare patients as physician practices are paid, so overall health care costs will go up and access will get even worse.

Legislators have to find ways to get more people insured with an insurance card that guarantees access to care. If health insurance that is adequate to cover the costs of care is not affordable, let’s work on solving that problem.

Health insurance companies are making a lot of profit, and the pharmacy benefit manager middlemen make even more. Administrative burden could be minimized.

Please help the doctors of New Mexico stay in practice and take care of the people we came here to serve.

Dr. Barbara L. McAneny, of Albuquerque, is a former president of the American Medical Association, co-chair of ONCare Alliance, and CEO of New Mexico Oncology Hematology Consultants.