Slimming Down Health Reform Won’t Work: Why We Can’t Just Expand Medicaid

Our guest blogger is Ellen-Marie Whelan, Associate Director of Health Policy and Senior Health Policy Analyst at the Center for American Progress Action Fund.

As a primary care nurse practitioner who has worked as one of those rare Medicaid providers in inner-city neighborhoods and in community health centers, I want to offer yet another view of why an incremental approach to health care reform won’t work.

One of the provisions that would likely be included in a pared down bill is some form of Medicaid expansion. But simply increasing the number of people eligible for Medicaid would not necessarily expand access to care. Why? Mostly because there aren’t enough Medicaid providers to service the current beneficiaries and expanding the program would only exacerbate provider shortages. Congress’ comprehensive approach to reform addressed this problem in several ways:

– Increased funding for Community Health Centers: These community clinics are already established in neighborhoods that serve Medicaid patients. The reform bills would expand and enhance these centers by allowing them to see an additional 35–45 million patients and ultimately save up to $23 billion through the provision of preventive services and better coordinated care.


– Increased funding for National Health Service Corps: The NHSC provides scholarships and loan repayment to health professionals who agree to work in areas with health professional shortages. The House and Senate health care bills provide funding for over 8,000 clinicians allowing them to serve millions of newly covered Americans.

– Boosting Medicaid primary care payments to Medicare rates: Medicaid typically pays significantly less than Medicare, which in turn tends to pay less than private insurance. As a result, it’s often hard to find providers to participate in the Medicaid program. The House bill would increase Medicaid payments to primary care doctors to same rates that Medicare pays. This would not only help Medicaid beneficiaries get access to care, it would also give an extra financial boost to primary care clinicians, who desperately need it.

– Increasing Medicare primary care payments: There is near universal agreement that we must increase reimbursement rates for services provided by primary care specialties. This would not only reward those currently delivering primary care but also help make the field of primary care more attractive by sending a message to medical students about what we think is important in the health care system. Many acknowledge this won’t completely solve the current primary care physician shortage but we are seeing some early indicators that it may be helping. Just this week, I learned that the University of New Mexico, Department of Family and Community Medicine has seen an uncharacteristically large increase in applicants into their family medicine residency programs — presumably because of the increased emphasis on primary care in the developing bill. Though this only directly affects Medicare beneficiaries, other payers undoubtedly follow Medicare’s lead.

So this is the puzzle of health care reform where Senator Rockefeller notes, “…Everything fits together.” “It’s very hard to say ‘We could just cut this out’ and do that.” Though I’d like to say the health care reform bill is a finely woven safety net, I don’t think it’s quite that secure. It is more like a quilt knitted together over this past year by many thoughtful individuals. Collectively it works but a few strands of yarn here and there just won’t offer the protection the nation desperately needs.