SIKESTON - The proposed 55-cent tax increase on cigarettes would be tough on smokers, but could make things much better for our children, according to pediatrician Kevin Blanton. Included with the tax hike is a provision that would increase Medicaid's physician reimbursement rates to match Medicare.
Blanton has been a strong and vocal advocate of this increased reimbursement but not for the reason many people may think. "It's perceived as wanting to increase physician reimbursement so doctors can make more money," said Blanton. His real concern, however, isn't physician incomes - it's that children with Medicaid coverage are not getting adequate access to health care.
While Missouri has one of the most liberal enrollment criteria for Medicaid eligibility, without participation by physicians it is useless, Blanton said. The decision to accept Medicaid patients is left up to each physician. And that decision is often influenced by the knowledge that they will receive less than half of their standard charges.
The cost of providing care often exceeds the reimbursement, Blanton said. "Many feel that they just can't afford, from a business standpoint, to take a substantial number of Medicaid patients."
The result is a large number of the state's children are unable to access the health care they really need. In Scott and New Madrid counties, between 40 and 50 percent of the child population is enrolled in Medicaid. In Mississippi and Pemiscot counties, enrollment is over 50 percent.
"The vast majority of patients on Medicaid are the working poor," Blanton said.
He added he has patients that come from Cape Girardeau because pediatricians there are simply not accepting any new Medicaid patients. As of Wednesday, the Standard Democrat was unable to find a single pediatrician or family practitioner willing to accept a child as a new Medicaid patient. "In Sikeston, at Ferguson Medical Group, the pediatricians and family doctors take care of kids regardless of their insurance status," Blanton said.
Many Medicaid patients resort to federally subsidized health clinics, but many of those, including the SEMO Health Network's Sikeston family clinic, do not have pediatricians as part of their staff.
Increasing Medicaid reimbursement to match the Medicare reimbursement, which is close enough to market value to result in more participation, has had dramatic results for other states such as Iowa, according to Blanton. "They have seen the problem of access to care disappear."
He is confident it could turn things around here as well: "If fees are increased to reasonable levels, the access problem would go away." Blanton said this has already been demonstrated in Missouri when the prenatal care reimbursement rate was nearly doubled, effectively eliminating access problems for expectant mothers.
While state officials claim there isn't enough money to increase Medicaid reimbursement for physicians, Blanton pointed out that pharmaceutical companies get 100 percent reimbursement on their drugs from Medicaid.
He estimated only 5 percent of Medicaid's budget goes to pay doctors who take care of children and that an increase of only 1 to 2 percent of Medicaid's budget would be enough to increase its reimbursement level up to Medicare's level. While this would still not reimburse the full regular prices, it would be close enough increase physician participation and improve access for kids, according to Blanton.
"People can help by contacting their local state representatives and senators and by contacting the governor," Blanton said. "Children do not have a high-powered lobby in Jefferson City to compete with pharmaceutical and insurance companies, so the only way that things will change is if the elected officials feel the heat from their constituents."
A coalition of Missouri physicians under the name "Kids Are Worth 100 Percent" is lobbying for the increase and the American Academy of Pediatricians has filed suit against some states "on the behalf of children because of the denial of access to care," according to Blanton.