The US Supreme Court agreed to review the case on only one question—whether individuals and private parties, including doctors and Medicaid recipients, can sue the state for failing to pay rates that meet the federal adequacy requirement. On October 3, 2011, the Supreme Court heard oral arguments in this group of cases, known as Douglas v. Independent Living Center of Southern California. ACOG joined the case in support of physicians.
Medicaid versus Medicare
It’s easy to see how important Medicaid is to women’s health, and how important physician payment rates are to women’s access to care. You might expect, then, that states would recognize the value of adequate physician payment—but they don’t, always.
At present, Medicaid pays for obstetric care at 93% of the Medicare rate. Still, obstetric care fares slightly better than many physician services. In many states, it costs physicians much more than Medicaid pays to provide non-obstetric care to Mediaid patients. Although 23 states pay for obstetric care at a rate lower than that offered by Medicare, 27 states offer greater support, and 16 states offer reimbursement well above the Medicare rate.
A federal target, too
The states aren’t the only entities with an eye on Medicaid cuts. The US Congress, too, is considering proposals to dramatically change the program. The options include issuing block grants for Medicaid; reducing the federal match; and including Medicaid in global or health spending caps. ACOG has an extensive campaign under way to ensure that any changes to Medicaid do not come at the expense of women’s health.
The Congressional Joint Special Committee on Deficit Reduction—more commonly known as the Supercommittee— represents the latest effort at deficit reduction. When its work imploded in December 2011, federal programs came online for a 2% across-the-board cut (“sequester”) that will take effect on January 1, 2013. The Medicaid program is exempt from this cut, no doubt in recognition of the already-precarious nature of this program, which has become a safety net for millions of American families struggling through the recession.
WHAT THIS DEVELOPMENT MEANS FOR CLINICAL PRACTICE
Because so many American women rely on Medicaid for obstetric and gynecologic care, it is critical that we protect funding levels and maintain eligibility for this program.
ACOG plays a prominent role in advocating for preservation of women’s access to care and adequate physician reimbursement levels. you can help by contacting your state legislators and representatives in the uS Congress to emphasize the importance of these efforts.
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