Medicaid changes will hurt patient access, doctors say

Poor children are in particular danger of skipping care due to new premiums and co-payments, according to congressional budget advisers.

By David Glendinning, AMNews staff. Feb. 27, 2006.

Washington -- Physicians worry that because Medicaid has opened the door to charging low-income beneficiaries more, they might start to see these patients coming through their own doors a whole lot less.

The deficit-reduction legislation President Bush signed earlier this month will for the first time give states the option of increasing premiums and co-payments on most types of beneficiaries in the program. States also will be able to move beneficiaries into special managed care plans that could offer less-generous benefit packages than they do at present.

The Bush administration said the revisions, which are part of a net package of about $4.8 billion in Medicaid reductions over five years, are necessary to slow the rate of growth in the federal-state health program. But physicians said it would take the public health system down a very dangerous road by putting the nation's poorest citizens at risk.

"This is a devastating blow delivered right to children," said Eileen M. Ouellette, MD, the American Academy of Pediatrics president. "I am outraged knowing that a majority of our congressional members believe sacrificing children's health care is acceptable."

The Congressional Budget Office predicted last month that roughly 9 million Medicaid beneficiaries, fully half of whom are children, will be subjected to co-payments for the first time under the new state flexibility. But only about 20% of the savings derived from this change will come from the collection of the payments. The remainder will come from the decreased use of medical services by this population, CBO said.