Medicaid: It's Broken

Five years ago, the Commonwealth of Massachusetts made a transforming decision about Medicaid.

Physicians, consumer advocates, and political leaders joined to add a new 25-cent tax on tobacco products to provide health insurance coverage for uninsured children. It was one of the most important and successful health policy decisions ever made in this state.

But more than that, this new policy dramatically changed how we think of Medicaid. In addition to simply being the public insurer for lower-income households, Medicaid became a last-resort insurer -- the state's vehicle for providing access to health care for everyone.

As a result, Medicaid has managed to move to center stage, covering almost one in every six residents of the Commonwealth. By virtue and force of its size, the Massachusetts Medicaid program now sets many of the local rules governing the state health care finance system, just as Medicare -- by its sheer size -- defines the environment in our federal health care system.

Our lawmakers cannot ignore the fact that when Medicaid sneezes, the entire health care system catches a cold. Medicaid is broken and has crumbled to the point where some doomsday scenarios are already here. Medicaid patients in many areas of the state lack access to specialist care. Physicians who accept Medicaid patients encounter difficulties that could potentially lead to a practice's financial ruin.

Physicians and patients alike have been subjected to repeated injuries from our state's Medicaid system. Last year, insult was layered upon injury when crossover payments were eliminated. The Massachusetts Health Care Task Force's recent recommendation for rate relief only to targeted physicians was timid and deeply disappointing.

We're approaching this problem on two fronts. First, with research: The House of Delegates has requested information on the precise payment denial rates for Medicaid and private insurance payers. Second, with action: The Committee on Tax-Supported Medical Care, your officers, and MMS staff have made the Medicaid issue a priority for the year.

You can count on our Society working to correct the inequities that we cannot address or correct as individual practitioners -- another example of how the Massachusetts Medical Society works for its members.

- Francis X. Rockett, M.D.