Guest column: Washington’s primary care Medicaid gap doesn’t balance out

In just the last year, more than 12,000 Benton County residents gained access to health care through the Medicaid expansion. It’s a good step toward better health in our area. But imagine having coverage and still not being able to get an appointment with a primary care provider when sick or ill, or struggling to get in promptly for a preventative check-up or immunizations. To tip that health coverage over into actual health, patients need to be able to see a provider when they need one.

It may sound obvious, but in some places that’s easier said than done when you’re a Medicaid patient. This isn’t simply about an overall shortage of providers. Washington has added thousands more Medicaid-covered patients, increasing demand for providers who accept Medicaid. But the Medicaid payments to providers for primary care are far below what it actually costs them to provide that care.

Thousands of new Medicaid enrollees combined with low Medicaid rates could add up to hundreds of thousands of dollars that primary care practices would need to absorb to provide care. It’s an unfair and unsustainable situation for many practices, forcing them to into a balancing act between taking additional or new Medicaid patients and keeping their doors open for care.

In anticipation of the Medicaid expansion, the federal government did raise Medicaid rates for primary care services, but that temporary increase expired in December. Noiw it’s up to the Washington legislature to maintain fair Medicaid payments for primary care services by including it in the budget.

Fair Medicaid payments and with it increased access to quality primary care and preventive services would balance out for the state, too. We know that not having access to primary care services delays needed care which raises the risk of serious illness, particularly for those with chronic conditions like asthma or diabetes, and can result in visits to the emergency room. It’s an expensive and inefficient way to provide care. Avoiding preventable emergency visits can save the state money, improve health outcomes overall and, ultimately, save lives.

Research studies in Washington showed a significant reduction in emergency department visits and hospitalizations as a result of enhanced access and use of primary care, particularly when integrated with mental health care. Nationally, an estimated 13 to 27 percent of emergency department visits could be managed in physician offices, clinics, and urgent care centers at a savings of $4.4 billion annually.

Fair Medicaid rates do improve patient access to primary care. A recent Washington state survey demonstrated that just over one-third of primary care physicians in smaller practices were willing to accept new or continue providing care for current Medicaid patients as a result of the temporary Medicaid payment increase.

Primary care providers are committed to caring for our patients. But if more Washingtonians covered with Medicaid isn’t balanced out with fair payments for the primary care services provided, many practices may not have the economic stability they need to fulfill that commitment.

We are asking our local legislators to support primary care services for our Medicaid patients. It makes sense for providers and for the state, but above all for insured citizens of Benton County. Their care depends on it.