Bill offers Medicaid break to doctors

One of the biggest issues facing Medicaid recipients is finding a doctor who will accept the generally low payments from the taxpayer-funded health program. The payments, which are lower than those provided by the Medicare program for seniors and the disabled and far below private insurance, often do not cover a doctor's costs.

Sen. Jason Crowell, R-Cape Girardeau, has filed a bill in anticipation of the upcoming session of the Missouri Legislature that would give doctors, nurses and dentists an added incentive to take Medicaid payments -- a tax break.

Crowell wants to allow those individual providers to deduct Medicaid payments from their taxable income. In the year that ended June 30, those payments totaled $206.7 million. The tax savings for the doctors, nurses and dentists would be about $12.4 million.

Crowell said he would like to raise Medicaid reimbursements to the level provided by Medicare, which more closely matches the costs for physicians. The tax deduction, he said, is one way to achieve that goal.

"It is an acknowledgment that we are not at the Medicare reimbursement rate and we are not covering costs," he said. "This is another way to hopefully prevent doctors, especially those providing specialist care, from refusing to see Medicaid patients."

The bill is part of an overall push to make health care more accessible and to create a reasonable way of providing treatment to Medicaid recipients, Crowell said.

Medicaid, known in Missouri as MO HealthNet following significant cuts imposed as a budget-balancing measure in 2005 and a legislative overhaul in 2007, seemed ready to be a major issue in the 2009 legislative session. Governor-elect Jay Nixon had made restoring the 2005 cuts a centerpiece of his campaign.

But since the election, recessionary pressures on state finances have turned a large state surplus of almost $833 million into an anticipated deficit of $342 million. That means the emphasis for the coming year should be on creating structures that give the 700,000 Missourians without health insurance access to coverage, access to doctors and access to preventive health measures, Crowell said.

"It is a new day in the state of Missouri, and tough economic times allow us to be more creative and reform-minded when you start trying to address health-care issues in the state," Crowell said. "The issue needs to be focused on access to health care in Missouri, not how many people we put on Medicaid rolls."

When a person becomes sick and has no insurance, they often resort to using hospital emergency rooms for treatment, Crowell said. That wastes money and the time of doctors and nurses who should be treating true emergencies rather than chronic illnesses, he said.

One state to view as a model, Crowell said, is North Carolina. The state pays doctors the same rates for seeing Medicaid patients as they are paid for Medicare patients, and each Medicaid patient is assigned to a general practitioner as a "health-care home."

MO HealthNet has a provision for a health-care home, but there are no incentives for doctors to sign up for the job, he said. North Carolina pays a doctor $3 a month for each patient enrolled with that physician for a health-care home.

The payment is not much, he said, but it makes sense and Missouri should adopt it. The doctor becomes responsible for counseling the patient on health issues such as smoking and obesity to prevent future, bigger medical costs.

"That will give us the greatest benefit as it relates to preventative medicine," Crowell said. "The question is, how do we truly foster a physician-patient relationship through a health-care home?"

A culture that encourages preventive medicine will mean big savings down the road, Crowell said. "We won't pay $3 a month to help manage some kind of element of health, but boy, we will pay for an open heart surgery," he said.

rkeller@semissourian.com

388-3642

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