Medicaid, what’s the point when most doctors don’t take it?

Medicaid, what’s the point when most doctors don’t take it?

In October 2023, my wife, Erin managed to get onto Medicaid, or KanCare as it’s called in Kansas, administered by a private insurance company, United Healthcare via the Working Healthy program.

Knowing how poorly administered the majority of government programs are in the United States, I was expecting issues with a switch from private insurance to the state-based KanCare government medical insurance program. But, I was not expecting the ridiculousness that has subsequently ensued.

Erin was awarded disability benefits about a year ago, which opened up the option of Medicaid. We were paying $657 per month for private medical insurance, and despite this premium, we have still amassed over $7,500 in medical debt because of deductibles and max out-of-pocket expenses in 2023 alone; that’s on top of $18,000+ of co-pay and drug debt paid on credit cards in previous years. And because we “earned” $18,000 extra from SSDI, plus my salary increased by 4% over the previous year, our premium would have been prohibitively expensive in 2024, losing most of our advanced tax credit.

Erin has a lot of medical issues, and because of this, she had a dozen doctors, many of whom she had had for years, but because of the switch to KanCare, she lost those doctors, bar one. Finding replacements for these doctors is incredibly hard; we have called 50+ doctors’ offices, and most of these offices do not take the state KanCare insurance. Some doctors even claim that it’s a nightmare having to work with Medicaid/KanCare; having trouble getting paid, and this is why they do not accept it.

We found a primary care office that takes Medicaid. But, it’s a residency clinic, i.e. newly qualified doctors doing their residency, a requirement to get a license to practice medicine as an independent physician in the United States. I am not criticizing this clinic; the resident doctor we have been assigned has been great in the first two visits with him, but when the only option is a teaching clinic, I see that as a problem. I suspect a lot of these doctors, once they complete their residency at the clinic, will not serve the people in most need, i.e. the people reliant on government-assisted medical insurance programs.

The next step is finding a pain medicine doctor. We have found a doctor in Hutchinson, a 104-mile round trip from Wichita, where we reside, willing to take KanCare. Not a single pain management doctor in the city of Wichita takes Medicaid. Not that the pain medicine doctors in Wichita are very good; most are pee in a cup, here’s your Hydrocodone. Not listening to their patients and ignoring patients’ pleas to try something else as the current regiment of drugs is not working, except for the last pain medicine doctor Erin had, who did try different drugs, but alas, we have lost him because of the switch to KanCare.

The pain medicine clinic in Hutchinson requires a referral; so we asked Erin’s one remaining doctor’s office, her rheumatologist, to send that referral; after a week of not hearing anything back, we called the Hutchinson Clinic, to find they had not received it. So, this past Thursday, we asked Erin’s primary care resident doctor to send a referral, which he did while we were in his office, and now we wait until after the new year to see if that referral was received and get an appointment to start pain management.

I come from the United Kingdom, where we have a national healthcare system; that is not free, as many Americans I have spoken to seem to believe; we simply pay 12% of our income. This percentage of our income covers all our healthcare needs: no co-pays, no co-insurance, no deductibles, no max out-of-pocket costs, and all doctors take the NHS insurance, barring a tiny percentage of private doctors.

This knowledge makes this situation even more intolerable; healthcare is not a right; healthcare is for the privileged, which is why so many people use the ER for their healthcare needs, either because they have no insurance or have insurance that is not worth the plastic card it’s printed on. The ER can treat the symptoms, but we need a system that encourages people to see a doctor for preventative medicine instead of reactive medicine. The ER is not a free solution, but unlike regular doctor’s offices, the ER has to treat anyone who walks in, with patients, incurring thousands of dollars in medical debt with each visit.

This is why the US has a type of bankruptcy specifically aimed at medical debt. The US is the only major country not offering a standard government-backed medical insurance program for all.

I would rather pay more tax for guaranteed healthcare; I already pay 1.4% of my income to Medicare tax. I’d happily pay another 10.6% in Medicare tax for guaranteed Medicare for all. And despite the bought and paid for (by interests in the medical field) American politicians’ assertions that Medicare for all could never work in the US, it would work, but doctors and drug companies would have to make less profit. If doctors’ only incentive is to make a fortune from medicine, I feel they have chosen the wrong career path; medicine should be about helping everyone, not just the privileged who can afford to pay.

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