Adding an estimated 19 million people into Medicaid by 2014 also may strain payments to physicians, which currently come in at only slightly more than half of what private insurance pays, according to the conservative Heritage Foundation. The lower payments already discourage doctors from accepting Medicaid payments, says G. Keith Smith, MD, an anesthesiologist in Oklahoma City, OK, who opposes the Supreme Court decision. "It is a disaster for physicians," Smithsays. "It's incredible how much more difficult it will be [for physicians] to see Medicare patients. Many will opt out. We're all scratching our heads and not making any headway. This is so dysfunctional."
In addition, Smith says, many physicians oppose the Independent Payment Advisory Board to contain cost growth in Medicare. As IPAB cuts reimbursements, seniors will experience growing access problems. Congressional committees continue to examine the IPAB.
In the meantime, the Supreme Court's decision to leave Medicaid coverage up to the states clearly will impact physicians and their workload. Before the court's decision, hospitals and providers were expecting millions of low-income and disabled patients to join Medicaid's ranks. Now, Republicans are ramping up efforts to thwart state involvement in Medicaid.
"I think physicians generally want to provide quality healthcare and I think there are going to be barriers," says Michael Fleming, MD, FAAFP, chief medical officer for Amedysis, a provider of home and healthcare based in Baton Rouge, La. Fleming described himself as generally neutral about the Supreme Court decision.