Obamacare: AMA’s Curious Support

Alyene Senger / June 20, 2013

Newscom

In an interview with Bloomberg’s Bureau of National Affairs, Dr. Ardis Dee Hoven, incoming president of the American Medical Association (AMA), said the AMA will push for full implementation of Obamacare, including its Medicaid expansion:

She said AMA continues to work on implementation issues with the states, and she called on physicians to work with their state agency representatives and elected officials to achieve ACA’s goals.

If Obamacare’s goals were fully realized and every state expanded its Medicaid program, an additional 25 million Americans would be enrolled in the broken program by 2021.

To be sure, Medicaid is consistently failing the population it is intended to serve, which makes the AMA’s support of expansion quite curious—especially given that Medicaid, on average, reimburses physicians only about 58 percent of what private insurance pays. Indeed, about one out of three doctors would not accept new Medicaid patients in 2011.

And while Obamacare was supposed to increase primary care physicians’ Medicaid reimbursement for 2013 and 2014 to Medicare levels, thus far that has not happened, and it remains unclear when or if that policy will be implemented.

Adding to the intrigue of AMA’s Medicaid expansion position is that it is simultaneously working to repeal Medicare’s scheduled physician payment cuts. Medicare on average pays physicians about 80 percent of what private insurance pays, and the sustainable growth rate (SGR) calls for about a 25 percent pay cut for doctors next year—potentially dropping Medicare’s payment slightly below Medicaid’s—which would severely hinder seniors’ ability to access care.

While nearly no one thinks the SGR’s implementation is good policy, it is striking that even as the AMA fights against the lower payments the SGR mandates in Medicare, it is enthusiastic about having more patients in Medicaid, which pays even less in reimbursement.

A Medicaid expansion would offer health coverage, but that is far different from patients being able to access health care. The severe access problem already existing in today’s Medicaid program (and getting worse under Obamacare) gives states and doctors yet another reason to reject a program expansion and hold out for patient-centered health care reform.