Stop Medical Emergency for Medicare/Medicaid Patients

Dozens of physicians from across Texas took time away from their medical practices to ask state leaders to reinstate cuts that harm access to care for thousands of Texas’ dual-eligible patients. Dual-eligible patients are old enough to qualify for Medicare and able to qualify for Medicaid assistance because of their income. Texas Medicaid slashed program funds over a year ago at the direction of the 2011 Texas Legislature, creating a medical emergency for hundreds of thousands dual-eligible patients and the doctors who care for them. “The increased regulation and low Medicaid payments are forcing doctors to leave the Valley or retire early,” said Victor Gonzalez, MD, Hidalgo-Starr County Medical Society president, and member of the Texas Medical Association (TMA) and Border Health Caucus (BHC). “It’s impossible to recruit young physicians.” The ophthalmologist lost six young physicians he trained and who received retina fellowships under his program. Dr. Gonzalez explains, “When the health care infrastructure collapses, it hurts all patients in the community and in neighboring cities. If patients can’t get care in a Harlingen emergency department (ED), they will end up in a San Antonio, Houston, or Dallas ED at a much greater expense.” For nearly a year, TMA and BHC physicians organized rallies, met with state leaders, and lobbied to get the cuts reversed. BHC is a confederation of county medical societies that work together to improve patient care and public health throughout South Texas. Many of the BHC doctors take care of large percentages of elderly, low-income patients. “Texas must fully reinstate the Medicaid cuts to ensure dual-eligible patients receive the health care they need to survive,” said Stephen L. Brotherton, MD, TMA’s president-elect. “We must take another step to stop Texas’ medical emergency that’s harming access to care for thousands of patients and their doctors.”

Background

Medicare and Medicaid pay dual-eligible patients’ medical bills, with Medicare paying a majority of the tab. In January 2012, Texas Medicaid stopped paying the patients’ Medicare deductible, which was $140 — this year its $147. Medicaid also stopped paying the patient’s coinsurance (due if Medicare’s payment to the physician exceeded what Medicaid pays for the same service, which is usually the case). The coinsurance had been an 80/20 split, with Medicare paying 80 percent of the patient’s doctor bill and in most cases, Medicaid paying the remaining 20 percent. These cuts affected approximately 320,000 dual-eligible patients in Texas, who are the oldest, sickest and most frail, and who rely on regular physician care and prescription medications. Doctors kept seeing these patients even though Texas Medicaid was not paying the patients’ deductibles nor fully paying all of the 20-percent coinsurance. Many doctors were forced to tap savings, obtain loans, cut staff, retire early, or move away. Some patients lost their doctor altogether. Other patients were more fortunate, like the 5,000 dual-eligible patients of Javier A. Saenz, MD, a family doctor in La Joya, Texas. “For months early last year he worked 12 hours every day, caring for his patients’ needs the best he could, while the State of Texas paid him basically nothing for providing all of that care,” said Dr. Gonzalez. “He exhausted his personal savings account of $50,000 and took out bank loans so he could keep his doors open and continue to care for the people of his community.”

Part of the Cut Restored

Finally last week, under the direction of the Texas Legislative Budget Board, the Texas Health and Human Services Commission restored coverage of the Medicare deductible for dual-eligible patients in 2013. “That’s a start,” said Dr. Brotherton, pleased that some relief has arrived. But the 20-percent coinsurance cut remains. “We’re asking state leaders and lawmakers to fully restore the funding for our Medicaid-Medicare dual-eligible patients,” said Luis M. Benavides, MD, the Border Health Caucus vice chair. “Our patients need us.” TMA is the largest state medical society in the nation, representing more than 47,000 physician and medical student members. It is located in Austin and has 120 component county medical societies around the state. TMA’s key objective since 1853 is to improve the health of all Texans.