GA Primary Care Docs Losing ACA Medicaid Payment Boost, But State Could Step In

Prior to 2013, Medicaid paid doctors on average nationwide only 59% of what Medicare would pay for primary care services, which itself pays less than what doctors typically bring in from private insurers. With the goal of increasing access to health care in mind, the Affordable Care Act provided a federally-funded temporary bump for Medicaid to 100% of Medicare primary care reimbursement rates from 2013 to 2014.

These boosted payments have now expired, and the AJC reports that doctors are concerned about the impact this will have on access to care for Georgia’s Medicaid patients. Since 1.8 million Georgians, including 43% of Georgia’s kids, get their health insurance through Medicaid, this is no isolated problem. Senator Renee Unterman (R-Buford), chair of the Health and Human Services Committee, supports addressing this payment drop-off and will be holding a hearing this Friday on the issue.

“We’re not just talking about poor people here. We’re talking about insurance holders who won’t be able to find doctors in their county because the doctors will have left,” Unterman said.

If the state does not act, Medicaid primary care payments will drop by 35% back to what Georgia paid to doctors in 2012: 65% of the amount that Medicare pays. Neighboring states Alabama and South Carolina have filled this funding gap, so it’s not inconceivable that Georgia could act. Keeping the boosted rates would cost just over $60 million in state dollars in FY 2016, which would bring in over $125 million in federal funds.

A recent fiscal note shows that raising the tobacco tax by $1.23 to the national average would bring in around $570 million annually, and at least one health care lobbyist has pointed to this potential revenue source as a way to boost provider payments. A rough estimate based on this fiscal note shows that only $0.13 more per cigarette pack (and its tobacco equivalents) would allow the state to eliminate this funding drop-0ff. This means there’s room for a tobacco tax hike that solves this problem while leaving plenty of new revenue for other state priorities.