Our views: Medicaid gaps must be filled

A mid some fanfare, Gov. Chris Gregoire last week unveiled her "Comprehensive Children's Health Care Plan" at Children's Hospital and Regional Medical Center in Seattle.

Under the governor's proposal, state government would:

Provide access to health care coverage to an additional 32,000 children.

Raise reimbursement rates for pediatricians.

Establish a so-called "medical home" for children so that all of the health care needs of a child are well coordinated.

Set nutrition and exercise goals for schools and educate children about healthy choices.

Set performance standards to measure the outcomes of services.

Ensure that children who are eligible for state programs are enrolled.

"A parent's first responsibility is to make sure that a child is healthy and safe," Gregoire said. "But gaps in our health care system make it difficult to ensure that every child receives the medical attention they need. I'm working to make changes in our health care system that families can count on, and have worked aggressively toward the goal of ensuring that every child in our state has access to health care coverage by 2010."

There's a lot to like about the governor's plan.

But physicians charged with treating sick and injured kids ask whether it's realistic to put another 32,000 children on state Medicaid rolls when those children already on state assistance can't get in to see a doctor.

Good question.

More and more doctors in this state are refusing to see children and adults insured through the state's Medicaid program, according to Tom Curry, executive director of the Washington State Medical Association. Doctors are refusing Medicaid patients because the state's reimbursement rates for physician services don't even cover the costs of providing that service.

According to Curry, for every $42 to $50 paid for a medical procedure by a private insurance company, Medicaid pays only $25. To be more specific, it costs a doctor about $42 to provide a routine office follow-up visit. Private insurance pays $65.08. Medicare, the federal program, pays $49.59 and Medicaid $29.66 The physician loses $12.10 for treating the Medicaid patient.

You cannot blame doctors for refusing to see Medicaid patients if they are losing money on every patient, Curry said.

Pity the poor patients whose only recourse is to scour the telephone book in a desperate search for a physician willing to listen to their story and take them on as a patient. Just ask the parents of the 16,831 kids in Thurston County on Medicaid. Turned down by one doc after another, many patients simply give up and go to the nearest hospital emergency room - the most costly setting for routine medical care.

Those who are paying for private insurance see their premium payments soar to cover the costs of treating the uninsured and underinsured.

It's incumbent upon the governor, the Legislature and the physicians to work together to resolve this Medicaid reimbursement issue. The governor's effort to get more children under state care is admirable. But that quest will ring hollow if those sick and injured kids cannot find a physician to treat them because of abysmal reimbursement rates under the state's Medicaid program.