Senator Redefines Medicaid ‘Access’ to Care

Senator Redefines Medicaid ‘Access’ to Care

State Senator Jack Tate is sponsoring a bill he believes offers Medicaid patients greater access to health care services and providers. Senate Bill 162 would allow a Medicaid recipient to receive and pay for medical services from a medical provider that is not enrolled in Medicaid. It has passed out of the Senate. In an interview with Catherine Strode, Senator Tate answers opponents’ claims that the bill will bring financial hardship to Medicaid recipients and a decline in Medicaid providers. Instead, he says it will bring patients true ‘access’ and choice in care.

Why have you brought this bill?
“The bill to me is about access, in the real meaning of the word access. This bill is about access for citizens and giving them real choices. One thing I’ve discovered down here at the Capitol is the way that our vocabulary is somewhat abused and distorted. The word access, in the parlance of some now, means affordability, something to do with price. When I hear people say something about access I ask, ‘Did a train derail and now block the road so you can’t get where you’re going? Or, you can’t physically get something that you want to procure?’ Or, is it against the law for you to get it?’ That, to me, is real access. It’s a phony euphemism when it’s used in all these other vehicles of price subsidation and affordability. Those are legitimate topics to have but I am a stickler for semantics.”

What is your definition of the word ‘access’?
“I found out in the law that there is a real legal barrier to access (health care) for some of our citizens. That caught my attention. The legal barrier is if you’re a Medicaid recipient, under the unusual and rare but sometimes important circumstance, that you want to go see a non-Medicaid enrolled provider, the law bars that private business clinician/patient relationship. I found it very strange. I did find several stories where there are circumstances upon which a Medicaid recipient might choose to go see a non-Medicaid enrolled provider. A Medicaid recipient might find it necessary, of their own volition, to see a non-Medicaid enrolled provider and make a private payment plan (sometimes funded by a third party in those circumstances.) To me, it’s a fundamental issue of true access. Those of us who have private insurance participate in a plan where at all times we have the freedom to go outside our plan and choose an out of network provider. That is that our personal decision, based on our needs at the time. In this case, I think it’s a fundamentally important that people have choice; and we are not, as a state, restricting the private choices of people.”

How do you answer opponents’ claim it could cause financial hardship for Medicaid recipients?
“I say, ‘I fully believe Medicaid recipients are capable of making informed choices for themselves.’ They can choose to stay in network, knowing they are going to get their health care provided for free. At a price point, that makes sense for them. But there are going to be circumstances where, rather than waiting for weeks to see a doctor, they may want to go and see a non-Medicaid enrolled provider and make their own agreement with that provider on how they are going to handle paying for that health care. We heard that in testimony in committee. Several women on Medicaid provided testimony and offered examples of how they wished they had had that choice, in certain circumstances.”

Does the bill provide any consumer protection?
“The bill will provide transparency requirements. I want to make sure whatever we do provides transparency and a full disclosure for people making decisions. Medicaid recipients would know up front what they’re agreeing to, how much that is going to cost, and how that cost compares to the usual customary charge. My belief is that Medicaid recipients will be in full awareness of the agreements they’re making. I don’t share that kind of patronizing view that folks on Medicaid can’t make decisions for themselves.”

Do you think the bill will drive providers away from Medicaid?
“I think this is a fallacious argument. If you think about a Medicaid provider, they know their patients. . To make a doctor quit being a Medicaid enrolled provider, they are going to have to look at their Medicaid patient pool and make a business decision and say, ‘I’m going to be better off becoming a non-Medicaid enrolled provider and I’m going to charge all these patients cash (knowing under most circumstances there is not an ability to pay.) That’s not a rational decision any provider will make. No provider is going to make an economic business decision to not be a Medicaid enrolled provider to charge cash to a patient population that doesn’t really have the resources to do this. There is no economic or business rationale that would compel a doctor to make that choice. They know the circumstances of their patient population.”

Are you surprised about the opposition the bill is drawing?
“Only because I am not yet a professional politician am I surprised. There is no shortage of misinformation down here. I do remember one person at the committee saying, ‘You can’t make Medicaid patients go pay cash for services.’ That just shows you, in the chaotic world of the Capitol, sometimes people get the wrong impression of legislation. It’s important for me to follow-up with them and make sure to calibrate their impression of what’s really in the bill and what its intent is to do.”