Do We Really Need a Medicaid Program?

By Dr. Alieta Eck | The Save Jersey Blog

In January, 2014, The Mercatus Center at George Mason University released a study that ranked New Jersey last in budget and long-run solvency, citing revenue shortfalls, budget practices and high levels of debt. So what are our legislators doing about it? Instead of raising taxes and fees and driving more residents out of the state, why not think outside the box?

Recent reports tell us that Medicaid enrollments have increased by 26% in NJ from September 2013 to September 2014. We now have $1.6 million enrolled in the $13 billion Medicaid program, out of a total NJ population of 8.9 million. Bureaucrats are calling this a triumph, as their goal seems to be having every one’s name on a list of people with insurance. “Insurance,” especially Medicaid does not necessarily mean access to medical care.

Taxpayers fork over $5,000 per non-nursing home applicant to a Medicaid HMO, and what do the patients get? More than half of NJ physicians do not take Medicaid due to the high administrative burden and low payments, so patients on Medicaid have a hard time getting access to care.

I am a physician who established the Zarephath Health Center, a non-government free clinic in central NJ, where volunteers care for the poor and uninsured. We see Medicaid patients who cannot find a Medicaid doctor. I saw a 35-year-old mother with severe asthma– on Medicaid, having gone to the emergency room a few days earlier. She was instructed to find a physician for follow-up treatment. Unable to find a doctor who takes Medicaid, she was welcomed at our clinic. I saw her, spent time hearing her story, examining her, and was happy to give her prescriptions to keep her asthma in check.

Last year many Medicaid patients came back claiming that pharmacies would not fill my prescriptions. I have a medical license, am board certified in internal medicine, and pay each year to keep my controlled-substances licenses updated, so why would they not honor my prescriptions? It turns out that I had not enrolled as a “non-billing Medicaid provider,” so the pharmacies were told they would not be paid if they filled my prescriptions.

When the patient called the Medicaid office, they instructed her to go back to the emergency room to get my prescriptions rewritten there—presumably copied by a physician enrolled in the program. Why would the Medicaid program deny her the medicines she needed? One would think they would appreciate the fact that a doctor was willing to see and care for her without costing the system anything. But apparently this is not how a bloated bureaucracy works. Things have quieted down and I have not recently heard had that same complaint– though I still have not enrolled as a “non-billing Medicaid provider.” Why should I need to do that?

Another Medicaid patient, a single mother of two, came complaining of abdominal pain. This had been going on for three months, and she had been to the emergency room several times. On the first visit they did an abdominal ultrasound and saw gallstones. But because her liver enzymes were not elevated and she had no fever, this was not considered an emergency. She was sent home and instructed to find a surgeon to take her gallbladder out. After making many phone calls, she never made it past the receptionists, as very few surgeons in private practice take Medicaid. Here is why. A dishwasher repairman is paid more than a doctor who takes Medicaid. Yet the doctor could be he could be held liable for hundreds of thousands of dollars if there is a bad outcome. Medicaid is a very costly, broken system.

Happily, someone told this patient about our clinic. We contacted a surgeon who said he would be pleased to help. The clinic, funded by private donations, paid him a fair fee without the exhaustive paperwork and claim forms. The patient was treated like a VIP. While we cannot do this on a wide scale, there are ways we could provide common sense to getting care for those in need.

So why do we have a Medicaid program? Is it about providing care, or about setting up a large bureaucracy to make it appear that the poor are getting care? What good is a program that enrolls patients but cannot enroll physicians?

We do not need the Affordable Care Act. In a sensible world, there would be three layers to provide optimal care for all at a reasonable cost: 1) Direct payment for routine care; 2) Low-priced, high-deductible health insurance for major medical events; and 3) Real non-government charity for those who cannot afford either.

Come let us reason together and throw off the government bureaucracy. Politicians ought not take credit for what doctors, nurses, hospitals, and communities do. It makes no sense for our government to fleece the taxpayers to erect barriers to care. And, as I stated at the outset, our state is clearly out of funds.

In NJ, we have proposed the Volunteer Medical Professional Protection Act, S94 and A3787, where physicians who donate four hours per week in or through a non-government free clinic like the Zarephath Health Center, would have medical malpractice protection for their private practices provided by the state. You can learn more about it at NJAAPS.org.

This is common sense health care reform which would make the Affordable Care Act unnecessary. Call your Senator and Assemblymen and tell them to co-sponsor and support this bill. Let’s make New Jersey first in fiscal responsibility and be the first state to enact real entitlement reform.

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1 thought on “Do We Really Need a Medicaid Program?

  1. And Dr. Eck lost an election to Ms. Coleman. That right there is why New Jersey is destined to fail. Nuff said…….

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