By Ana B. IbarraJune 22, 2017
Some political observers
were surprised when two
Republican congressmen from California’s Central Valley voted for the GOP-led
House bill to repeal the Affordable Care Act and curtail federal spending on
Medicaid, the health program for low-income people.
After all, thousands
of people in their districts could lose their health coverage if the bill
became law.
Now, Reps. David
Valadao (R-Hanford) and Jeff Denham (R-Turlock) have introduced legislationof their own
to increase payments for doctors who treat Medicaid patients. Medicaid
reimbursement rates in California are among the nation’s lowest, hampering some
patients’ access to care.
Critics say the bill
is short on details, and they call it a “distraction” from what they view as
the congressmen’s votes to strip health coverage from their own constituents.
“The proposal is
really embarrassingly transparent in its attempt to change the focus of
discussion away from basic coverage for low-income folks,” said John Capitman,
executive director of the Fresno-based Central Valley Health Policy Institute.
The Denham-Valadao
bill, currently in the House Committee on Energy and Commerce, would require
federal health officials to study ways to boost doctors’ Medicaid pay in an
unspecified region with a disproportionately high number of Medicaid patients,
with the goal of improving access to care. Most counties in California’s
heartland fit that description. In Fresno County, the seat of the Central
Valley, half the population is
covered by Medi-Cal, California’s version of Medicaid
Denham defended the
bill, saying it is one of many to come that will build upon the “repeal and
replace” legislation known as the American Health Care Act (AHCA). The Senate’s
version of the bill, crafted in secret, was
expected to be released Thursday.
“We have the AHCA,
which we expect is going to come back differently in the Senate, so we’ve got
more opportunities to make changes,” Denham said in an interview. “It’s
one thing to have an insurance card, but if their deductibles are too high or
they have no doctor that will see them, then they really still have no
coverage.”
The Denham-Valadao
bill does not specify the cost of the Medicaid pilot project it seeks to
establish, nor does it say what kind of payment-boosting methods could be
tested or how long the study would last. That lack of detail makes it difficult
to analyze the legislation’s impact, some health policy experts said.
Capitman agreed that
higher reimbursement rates could encourage more Central Valley doctors to see
Medi-Cal patients, but that alone wouldn’t draw more physicians to the region.
Chris Perrone,
director of the Improving Access team at the California Health Care Foundation,
said boosting Medicaid rates while stripping coverage from some people is
illogical and would not make it easier for doctors to sustain a practice.
(California Healthline is an editorially independent publication of the
California Health Care Foundation.)
“If the goal is to
improve access to care, the place to start is not with reimbursements. The
place to start is with coverage,” Perrone said. “To vote for a bill that pulls
back Medicaid expansion and then to propose this other bill is preposterous.”
However, Lanhee Chen,
a health policy expert at the Hoover Institution, praised the Denham-Valadao
bill as an opportunity to find a solution for one of Medicaid’s most pressing
problems.
But Chen noted that
while low Medicaid payment rates are a matter of some urgency in California
that is not the case in many other states. Others “will most likely see this as
a California issue, rather than a national problem, so it might be difficult
for this to gain traction nationally,” he said.
Cathy Frey, CEO of the
Central Valley Health Network, based in Sacramento, said the new proposal by
Denham and Valadao could be a response to the heat they are feeling from their
constituents, since the congressmen voted for the AHCA in May.
Earlier this year,
before Valadao’s AHCA vote, Frey’s group had given him a “Health Champion”
award for his leadership in “promoting sensible healthcare policies” and his
support of community health centers in the Valley.
His support for a plan
that could potentially end coverage for some of the patients those health
centers serve came as a surprise, Frey said.
“Disappointment is the
word that comes to mind,” she said.
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