Medicaid Reimbursement Rates Are a Feminist Issue

I generally try not to say anything negative about specific doctors, clinics or hospitals in any printed format, including online, because let’s face it: those folks have better lawyers than I do and they could sue the pants off of me, even though every word I’ve said is true (to the best of my knowledge and recollection).

Still, l had something happen at a doctor’s appointment recently that I think needs to be talked about. It doesn’t matter who the doctor was or where the clinic was. It doesn’t even matter whether the doctor was a man or a woman. It’s a long story, but I was treated very poorly and I actually walked out of the appointment. The doctor was rude, abrasive and extremely condescending. S/he acted as if s/he didn’t want to treat me, as if my case was too complicated and time consuming.

I believe I was discriminated against because I have Medicaid for my health insurance. After I left, I couldn’t figure out why a doctor would treat a patient that badly and the best explanation I can come up with is that s/he wasn’t getting paid enough to make my case worth her/his time and energy.

In other words, the Medicaid reimbursement rates in our area must be pretty low and if a doctor is driven by profit, taking a case like mine would not be cost-effective. This concerns me, not just on a personal level, but on a national level as well. 1 in 10 women receives her health coverage through Medicaid. For low-income women, this statistic is even higher: 1 in 5 women have Medicaid. These numbers are only expected to rise as approximately 17 million people will be enrolled in Medicaid as health care reform is enacted over the new few years.

Increasing Medicaid enrollment without boosting doctors’ reimbursement rates leaves poor and disabled women open to discrimination and abuse.

I worry that even if a doctor does accept patients with Medicaid, some patients with complicated cases will be turned away by doctors who don’t want to treat them. If they are lucky enough to find a doctor, they may be forced to accept substandard care or facilities. During the health care debate last winter, Sen. Lamar Alexander (R-TN) called Medicaid:

a medical ghetto called Medicaid that none of us, or any of our families, would ever want to be a part of for our health care.”

After thinking about it, I can see that I’ve had the best experiences with Medicaid providers who were part of large clinics and/or hospitals. It always seems to be the independent contractors – the little guys and gals at private clinics – who either refuse to treat me or have a lousy bedside manner when they do.

The Department of Health and Human Services (HHS) even admits that it doesn’t pay for some doctors to take the cheap Medicaid patients on:

Medicaid payment is often very low. Low payment rates discourage provider participation in Medicaid… Rural areas usually do not have sufficient patients to fully support a doctor’s practice.

The HHS website I linked above goes on to list suggestions for how the Health Resources and Services Administration can use Medicaid funding to improve rural health care for Medicaid patients but at the end of the day, money talks: Congress will have to increase the reimbursement rates so doctors can afford to treat Medicaid patients. As feminists, we need to push Congress to do this so women and girls on Medicaid (and Medicare) receive the best health care possible.

Driving home from that doctor’s appointment a few weeks ago, I was angry and upset, not only for me but also for the millions of other women who are currently on Medicaid or will be soon. Regardless of our income level or what insurance we have, we all deserve dignity, respect and first-class health care.