BY ANNE STANTON
TRAVERSE CITY —
Michigan is poised to add another 500,000 patients next year to Medicaid rolls if the state legislature and governor can be convinced.
But the question remains: Is the move an empty promise or a real step forward in the Affordable Care Act's effort to ensure health care coverage for all Americans, including the poor and uninsured.
Many health care professionals have doubts. Only 25 percent of regional doctors are accepting new Medicaid adult patients, and not a single primary care doctor is accepting new Medicaid patients with chronic pain, according to a report by HealthLink, a Munson Healthcare service that helps patients find a physician.
"It's kind of like an empty promise, said Jeffrey Wentzloff, an ophthalmologist and partner of Grand Traverse Ophthalmology.
"If you tell people they're going to get health care, and the solution is Medicaid, then is it a real solution? I would argue it is not."
Wentzloff's practice accepts Medicaid patients, but loses money on each patient.
For the next two years, the Affordable Care Act requires states to amp up Medicaid payments to primary care physicians to the level of Medicare rates. The change is fully funded by the federal government, but for only two years.
Richard Nielsen, a physician and managing partner of Crystal Lake Clinic, said he's found a way to make the existing rates work. His eight regional clinics serve 50,000 patients, including roughly 13,000 Medicaid patients.
Nielsen credits his success to switching to electronic medical records 10 years ago, when most doctors were mulling it over. He also uses a higher percentage of nurse practitioners and partners with nearby hosptitals to provide patient care.
"We just went into Grand Traverse County because people were calling Munson's 800 number and nobody was taking them. They had nowhere to go. Reimbursement is bad, but we're doing it," he said.
Because the Medicare and Medicaid programs are under the Congressional spotlight, Nielsen isn't counting on higher reimbursement rates.
"We just do a good job and play the cards we have," Nielsen said.
The Traverse Health Clinic will receive a huge financial boost if the state legislature approves the new eligibility guidelines. Sixty percent of its uninsured patients will qualify for Medicaid, said CEO Arlene Brennan.
"Gov. Snyder has been very favorable, but the legislature has not been supportive," Brennan said.
Mike Forness, a pediatric orthopedic surgeon formerly of Traverse City, argues fundamental change is required. Half of the country's kids are on Medicaid, and that makes it very difficult for pediatric specialists to provide treatment without losing money.
"Why is it okay for kids to be on Medicaid, not Medicare? Are they less important than seniors?" said Forness, who joined the staff of DeVos Children's Hospital in Grand Rapids a few years ago.
Despite the uncertainties, Mary Ellen Hulwick, who works in the Munson Family Practice Center billing office, said the Affordable Care Act so far has been positive.
More young adults are coming in because they can continue longer on their family's insurance plan.
"We're seeing a lot more people here for wellness visits — patients who would never come at all because that's covered now. I do know more patients are getting flu shots because they're covered, too."