Medicaid Expansion: What’s Your Take?

By ThriveAP Team Member Leonel Cabrera

One of the top issues bearing weight on the medical community today is Medicaid expansion under the Affordable Care Act.  Typically, medical providers take two stances in this debate: to support Medicaid expansion and therefore encourage providers to provide charitable care or to claim that it is unacceptable to continue seeing more patients with government plans and corresponding low reimbursement rates- after all, healthcare is a business.

There are pros and cons to both sides of the Medicaid expansion argument, but if one makes a decision it seems to be based on emotion vs. logic.

Since its emergence in 1965, Medicaid has historically provided medical care to low income mothers, pregnant women and individuals with disabilities that prevent them from working.  Now, with the Affordable Care Act, the “safety net” for eligible patients will expand to up to 133% of the poverty line.  This means the number of patients covered by Medicaid will rise dramatically.

The catch, however is that Medicaid offers low reimbursement rates to medical providers so they are compelled to render services for a low cost.  Certainly, for the physician’s and other medical provider’s perspectives, it does not seem fair to work for others without financial incentives in return. How will medical providers keep their businesses running smoothly in the face of financial setbacks?  How will they pay their employees?  How will their monstrous student loans get paid?  These are just some of the factors keeping medical providers from leaning towards reform.

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According to a study by technology firm HealthPocket, out of more than 1 million doctors only 43% accept Medicaid.  It can be argued that Medicaid os one reason many doctors are deciding to leave the profession as there is less incentive to produce.  Many physicians refuse to accept Medicaid and others make it as difficult as possible for patients to receive treatment as it would represent lost income.

For nurse practitioners and physician assistants, there may be another story.  If Medicaid is a doctor’s curse, it could be a advanced practice provider’s eventual blessing.  As more doctors hang up their scrubs, other providers have the chance to expand their scope of practice convincing naysayers they are capable of performing most of the duties of a primary care physician.  As of now, only 16 states allow nurse practitioners to operate an independent practice.  That will change with the implementation of the Affordable Care Act looming.

It looks as if there are going to be winners and losers with healthcare reform.  Right now, physicians are fighting a losing battle.  The reality is hard to swallow, but a compromise must be reached between the reason many physicians enter practice, to save another person’s life, and rightfully demanding their financial worth.

What do you think about Medicaid expansion as a nurse practitioner or physician assistant?


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