Tuesday, December 18, 2012

Emergency Partially Averted: Some Coverage Reinstated for Poor, Sick Texans

Texas’ “medical emergency” has been partially averted. The Texas Legislative Budget Board has directed the Health and Human Services Commission (HHSC) to restore part of a cut in payments for patients covered by both Medicare and Medicaid. Because they qualify for both government health insurance programs, these patients are sometimes called “dual-eligible” patients. They are often the poorest and sickest Texans.

For nearly a year, physicians of the Texas Medical Association (TMA) have organized rallies, met with state leaders, and lobbied to stop the cuts. Many of the doctors advocating on behalf of their patients for coverage see large percentages of dual-eligible patients.

“It’s a great first step,” said TMA President Michael E. Speer, MD. “Physicians across the state and their patients have been reeling from the impact of these cuts for almost a year. We definitely needed a reprieve. Since January, it’s been a true medical emergency.”

The news comes not a moment too soon, as physicians face a possible 27.5-percent cut in Medicare/TRICARE payments Jan. 1 for senior citizens, people with disabilities, and military families.

Dr. Speer added that because of the dual-eligible cut, physicians who care for these patients have had to borrow money to keep their doors open, lay off staff, drop out of Medicaid, or even close their medical practices.

One such doctor affected by the cut was Javier Saenz, MD, a family physician in La Joya, on the Texas-Mexico border. To serve his patients and keep his medical practice open, Dr. Saenz exhausted his personal savings and turned to bank loans to make payroll.

“This is such a relief,” said Dr. Saenz of the reversal. “It’s truly a Godsend and a step in the right direction so we can continue to help these patients we know and love. I had to go through my personal money to keep my office open. If I had no savings whatsoever, this office would have closed.” Now he says he can keep his doors open and continue to see his 5,000 dual-eligible patients, though he hopes funding is restored completely. “We are not out of the woods yet.”

Reversing the cut was one of the top priorities identified by TMA’s Physicians Medicaid Congress. Dr. Speer said TMA will continue to pressure lawmakers when the legislature convenes in January to restore the remainder of the cut.

“We now urge lawmakers to eliminate the rest of this cut as soon as possible,” Dr. Speer said. “While this cut has disproportionately impacted dual-eligible patients with disabilities and seniors, when physicians are forced to close their doors or reduce services, it affects all of our patients.”

Read the full TMA news release.

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