Wednesday, March 02, 2005

The Use of Market Forces by the State.....
Medicaid in Georgia is a real mess. Reimbursement is lousy and many physicians do not participate. It is becoming an access issue in many parts of the state. So a bill has been introduced in the General Assembly to attempt to remedy the situation. From House Bill 73:
A physician, as defined in Code Section 43-34-20, who participates in the state employeeś health insurance plan as provided for by Article 1 of Chapter 18 of Title 45 or in the board of regentś health insurance plan as provided for by subsection (e) of Code Section 31-5A-4 shall be required to participate in the Medicaid program. If at any point a physician is no longer eligible or declines to participate in the Medicaid program, such physician shall no longer be eligible to participate in either the state employee's or the board of regent's health insurance plan

So if you don't participate in Medicaid, you are excluded from State Merit. Is this the right thing for the state to do? The state is not doing anything that many private insurance companies don't already do. That is, not allowing a physician to participate in the PPO (or premiere plan) without participating in the HMO (or basic plan). So is it any more "evil", for lack of a better word, for the state to do it?
Now if the law mandated participation in Medicaid as a condition of licensure, I would agree wholeheartedly that the state had gone too far. A state-mandated assessment of licensed physicians to start up a liability insurance company is out-of-bounds as well. What's the difference? Because the state is using it's oft debated monopoly on licensure to compel behavior beyond what is required for patient safety. But here the state is using the market (access to insured lives) to affect behavior. No physician has a "right" to participate in State Merit or Medicaid, anymore than they have the "right" to be on the provider panel for any commercial insurance plan.
I do this sort of thing all the time, but sort of backwards. If you don't consult me on insured patients during daylight hours, don't expect me to take care of your indigent cases in the middle of the night.
The specialists I have spoken to don't like it, since most of them have cut Medicaid patients from their practice, and would be faced with the decision as to whether continue to participate in State Merit.
The primary care physicians I have spoken to love it. They hope that this will help to end some of the difficulties they have had in getting patients to see specialists.
The bill doesn't appear to me moving very fast, so things may not change.
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