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Equal Pay for Equal Work

By Dr. Nilesh Kalyanaraman

I love it when I see Medicaid patients on my schedule for the day. Working at a community health center, our doors are open to all people, regardless of their ability to pay. It’s hard to run a medical office when you get $20 for a visit, which is what our uninsured patients pay. So when a patient has Medicaid we know we’ll get paid a decent reimbursement for that visit.


On average, Medicaid pays 34% less for a primary care visit than Medicare, which itself pays less than private insurance. In contrast to my situation, many doctors won’t take Medicaid because it pays so much less than what they’re getting from their other patients with private insurance. The people covered by Medicaid - poor women, children, the elderly sick and the disabled - need more choices of where they can get their care, not fewer.


Which is why it was great news to hear earlier this week that because of the Affordable Care Act, in 2013 and 2014 Medicaid rates will increase to be the same as Medicare rates. This should get more doctors to participate in Medicaid which will expand access for this vulnerable population.


Just as important, it corrects an injustice. The message of the current payment structure is that society, by paying less for Medicaid than for Medicare, values the lives of the poor less than the elderly.  It speaks ill of us when we short change vulnerable populations because they can’t afford lobbyists and devalue the providers taking care of them by paying them less for equal work.


For our clinic it will mean that we will be able to expand our services. We will finally be able to buy an audiometer to screen children for hearing problems. We can get more vaccines to vaccinate our diabetics. We can subsidize medication costs for those who can’t afford it. And, we can see even more uninsured patients with the extra money that we get.


The cost of all this is $5.5 billion dollars a year which is just over a 1% increase in the budget for Medicaid. It’s already paid for since it’s a part of the Affordable Care Act but there’s a showdown coming in 2015 when this pay increase is set to expire. Ideally, this pay disparity will be eliminated once and for all but that seems a dim prospect given the way this Congress operates.   So when the time comes to fight, ask yourself this: Isn’t caring for your child worth at least as much as caring for your parents?

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