Op Ed: Medicaid and The Disabled, A Journeyman’s View

A reflection from Tom Pyle, PsychOdyssey’s director:

I’ve just read a good article about Medicaid and the disabled, called Special Interests Obscure Truth That Expanding Medicaid Makes Disabled Americans Suffer. I recommend it to all navigating the maelstrom of mental illness who have loved ones on Medicaid. See the article here.

I do a lot of work with families of loved ones with disabilities. In the process I have had to become very familiar with the Medicaid program. Because of the negative effects Medicaid expansion has had on the disabled population, I take a contrary view to the majority of mental health advocates about the current Medicaid debates. For instance, I am not a fan of the Medicaid expansion of the Affordable Care Act, which increased Medicaid’s roles by 25%, mostly with able-bodied uninsureds. Medicaid was originally most intended for the really poor and severely disabled.

The expansion has pressurized Medicaid in 5 ways:

1. It has increased ACCESS to the program by 25%, one of its stated goals. Access effectively means receiving a Medicaid card by which one can access the Medicaid program But…

2. It has not increased AVAILABILITY of providers. So, waiting rooms have 25% more patients waiting to see essentially the same number of doctors. Also, in my state, NJ, which has the lowest Medicaid rates in the country, we have the highest rate of physicians (60%) not accepting new Medicaid patients.The rates are unattractive to providers. (In my home county of Mercer in NJ, there is not one private psychiatrist who accepts Medicaid!…)

3. The expansion doesn’t likely improve care QUALITY, one of the ACA’s goals. How could it, with 25% more patients trying to see a shrinking number of doctors–or, these days, more likely, “force extenders” like APNs or medical students?

4. The expansion doesn’t likely reduce COSTS, a major ACA objective. It does impose caps on rates, which reduce incentives for providers. This leads to lower quality of care and less frequent care, which leads to recidivism at the hospital ER, etc. etc.

5. Finally, given all this, the expansion hobbles INNOVATION. There’s not enough money in the current system to set aside enough to pioneer breakthrough solutions. Sure, some state Medicaid programs are doing interesting “pilot” programs with Federal approval. But these programs are often about rearranging the deck chairs on the ship rather than remodeling the hull.

These are my impressions from real life. Perhaps some academic study will prove my impressions statistically wrong, in which case I will have to reconsider. Until then, since I carry such thoughts in mind from my real-world experience with Medicaid and the disabled, this article speaks to my realities.

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