Health officials say Medicaid expansion better than nothing
CHARLESTON, W.Va. - It's better than nothing.
That's the view some local health care providers are taking of Gov. Earl Ray Tomblin's announced expansion of Medicaid, expected to bring an additional 91,500 West Virginians into the federal insurance program beginning next year.
Hospital officials say Medicaid's reimbursements are notoriously low, only 20 cents on the dollar in some cases.
But that is still better than what most uninsured patients currently pay: nothing.
Tomblin made his Medicaid announcement Thursday morning at a press conference at St. Francis Hospital in downtown Charleston.
He said expanding the program "is the best choice for West Virginia" and, while there are costs associated with the expansion, the state would bring in $1.3 billion of federal dollars during the first three years of the program.
Under the expansion, the state also expects the number of uninsured West Virginians to drop from 246,000 to 76,000 by 2016.
Steve Dexter, president and CEO of Thomas Health System, which covers St. Francis and Thomas Memorial Hospital in South Charleston, said Medicaid traditionally has not paid hospitals enough to recoup costs.
While private insurance companies pay St. Francis about 20 cents above cost, Medicaid only pays the hospital about 20 cents on the dollar.
But Dexter said increasing the number of people on Medicaid could help the hospital's bottom line in the future.
Uninsured patients pay, on average, about five cents on the dollar. Hospitals are required by law to treat patients, regardless of their ability to pay their bills. Dexter said some patients try to pay the hospitals back, but most don't pay anything at all.
Dexter said those patients also are among the most expensive to treat, because they often don't arrive at the hospital until they are chronically ill.
"We've had patients come in that had stage four breast cancer," Dexter said. "You catch that at stage one, and maybe it's a minor surgery."
When asked about Medicaid's low reimbursement rates, Sen. Ron Stollings, D-Boone, said they also are difficult on private physicians. But he said the benefits of the Medicaid expansion would outweigh any problems.
"I don't think you're going to see any doctors going out of business because of this expansion. The physicians will step up to the plate," he said.
Stollings, a doctor who specializes in geriatric care, runs a private practice in Madison.
"I see people all the time in rural West Virginia that do not have insurance or access to care," he said.
He said doctors worried about an increase of Medicaid patients should "look at this as an investment," because patients now will seek treatment long before they develop full-blown conditions.
Stollings has treated patients who came down with bronchitis, did not seek treatment because they lacked health insurance, and eventually wound up hospitalized for pneumonia.
He also has seen patients in their 30s with severe kidney problems because they did not adequately control their diabetes.
Stollings said he also anticipates changes to the way doctors and hospitals are paid in coming years.
Other segments of the health care community are expecting immediate benefits from the Medicaid expansion.
Dr. Rahul Gupta, executive director of the Kanawha-Charleston Health Department, said expanding the federal insurance program would be a "game changer" for public health departments, which largely serve uninsured or under-insured people.
Health departments rely mostly on county and state tax dollars to stay afloat. Under the expansion, Gupta said many of his patients now would have insurance, allowing the health department to bill for its services.
Instead of relying on tax money and grants, the health departments would collect revenues just like private doctors offices and hospitals. That would allow current tax monies to be rerouted, and help expand health department services, Gupta said.
"We feel this is an advantage," he said. "If we can generate these revenues, it'll go back into the community."
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