The mortal threat to Medicaid -- and how to fix it

That was the expiration day of a two-year bump in Medicaid reimbursements for primary care physicians seeing Medicaid patients. The raise, which was part of the Affordable Care Act, temporarily raised Medicaid rates to the level of Medicare reimbursements; the expiration means a drop averaging nearly 43% nationwide, according to calculations by the Urban Institute.

The wider the gap between Medicare and pre-ACA Medicaid rates for primary care, the bigger the drop. In California, where primary care reimbursements for Medi-Cal, the state's Medicaid program, are among the lowest in the country, the drop in reimbursements will be close to 59%. The consequences are self-evident. As the Urban Institute observes: "Significant drops in primary care reimbursement may lead physicians to see fewer Medicaid patients, potentially leading these patients to have difficulty finding a physician or getting an appointment."

The ACA gave states the option of continuing the Medicaid raise from their own funds. Unsurprisingly, most have declined to do so. The Urban Institute found only 15 states that had decided to continue the higher reimbursements, and 12 others that were "undecided" as of the date of its survey, which was published in December.