Wednesday, June 22, 2011

Access Denied

If you live in Cook County, IL, are a parent, and have Medicaid+CHIP coverage for your children--you may be SOL when it comes to specialty medical care. However, you may already know this if you've tried to get an appointment with a psychiatrist or neurologist. Now everyone else knows it too, thanks to a new study published in the (June 16) New England Journal of Medicine. MSNBC reports:
Although past research has shown a disparity in care between people covered by public and private health insurance, this is the first to take a comprehensive look at specialty care in children, said coauthor Dr. Karin Rhodes of the University of Pennsylvania.

"We had an idea that this was a problem, but we didn't know the magnitude of it," she told Reuters Health.

[...]

Federal law says that Medicaid recipients must have the same access to care as the general population.

During the first five months of 2010, female callers posed as mothers whose child needed specialty care for serious conditions such as severe depression, diabetes and seizures. They tried to get appointments at 273 specialty clinics in Cook County, Illinois. At one point they said they had private insurance; at another, they offered an identical scenario but said the child had Medicaid and CHIP coverage.

While care was denied in only 11% of the clinics when private insurance coverage was offered, the denial rate was 66% when the clinic was told the child was covered by public insurance.

And in the case where Medicaid-CHIP insurance was accepted, those children were told that they would have to wait, on average, 22 days longer than those covered by private insurance.

The typical wait for an appointment was 20 days in the private coverage group and 42 days for Medicaid-CHIP.

The trend was seen across all seven specialties tested -- orthopedics, psychiatry, asthma, neurology, endocrinology, otolaryngology and dermatology.

Rhodes and coauthor Joanna Bisgaier, also of the University of Pennsylvania, selected conditions "that were very common and where there's evidence that specialty intervention can make a difference in long-term outcomes," Rhodes said.

One woman who called seeking treatment for a child's newly-diagnosed type 1 diabetes was told that the wait would be one year.

Even for the children with private insurance who could get an appointment, on average, after 20 days, "just having to wait three weeks with a kid with a new onset seizure, or diabetes, or poorly-controlled asthma, or a fracture is disturbing in itself," Rhodes said.

"You add an extra 22 days on to that, and what you've got is disparities, discrimination that is purely based on insurance."
There really aren't words to adequately describe how appalling and unacceptable this is. Rhodes went on to say:
Every state should be studying their access, particularly if they're considering cuts to Medicaid because they're cash-strapped and they think they're going to take it out of their healthcare budget. If we keep whittling away at these programs, we will increase the disparities."
Logic! Logic, however, doesn't seem to go very far these days. Indiana is playing chicken with Medicaid money and NJ is has a garbage brain governor who proposed cutting Medicaid eligibility to families of 3 who make less than $6K/year. They aren't the only ones as several other states are looking to slash Medicaid and drop people from the program. As this article notes:
To hold down costs, states are cutting Medicaid payments to doctors and hospitals, limiting benefits for Medicaid recipients, reducing the scope of covered services, requiring beneficiaries to pay larger co-payments, and expanding the use of managed care.

[...]

Neither the White House nor Congress has tried to extend the extra federal financing for Medicaid, even though the number of beneficiaries is higher now than when Congress approved the aid as part of an economic recovery package in February 2009.
Of course neither has tried. That simply wouldn't do, would it President Obama? Would it, Paul Ryan? Compassion doesn't seem to go very far, either.