An alternative to Medicaid expansion … “One solution is increasing low-income Floridians’ access to DPC …”

Special to The Tampa Tribune
Published: April 11, 2015

Doing the same thing over and over again and expecting different results is, in the words of Einstein, the definition of insanity. Unfortunately for Floridians, so too are the calls today to expand our state’s Medicaid system under the Affordable Care Act.

After decades of failed reforms, this $450 billion federal health care system remains woefully insufficient to address the health care needs of our state’s poor. It is unaffordable, limits access to health care and delivers poor results for patients. Florida House Speaker Steve Crisafulli and his House colleagues deserve much credit for their principled opposition to this plan, especially given the politically expedient alternative of allowing it to go through.

But what should we do instead? Rather than the one-size-fits-all approach of the federal government, Florida should pursue a number of patient-centered reforms that have been proven to lower costs, increase access and improve the overall quality of care.

First and foremost, we have to rein in Medicaid’s runaway costs. With a nation already $18 trillion in debt, we simply cannot afford expanding the entitlement state into infinity.

One solution is increasing low-income Floridians’ access to direct primary care. Unlike traditional fee-for-service practices that accept insurance at every visit, DPC has flat monthly fees averaging between $50 and $125. No premiums. No copays. No surprise bills months later. This covers all the primary care a patient needs, from preventive services like checkups and vaccinations to casts for simple broken bones.

Noticeably absent from this arrangement are third-party payers like insurance companies and government programs like Medicaid. Removing these middlemen allows medical providers to lower costs and focus exclusively on their patients’ wellbeing — and the results are striking.

A study published in the American Journal of Managed Care found one DPC practice was able to save $2,551 per patient. The savings were especially profound for patients suffering chronic conditions, which are the most time consuming and costly to our health care system. These patients also had 56 percent fewer nonelective hospital admissions, 49 percent fewer avoidable admissions, and 63 percent fewer nonavoidable admissions.

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Of course, there are many who can’t afford a single dollar of health care. And there will be procedures which direct primary care cannot cover. For these people, the state can develop targeted programs that are narrowly tailored to address these specific needs.

Reforms are also available to increase access to health care for our poor and under-served. This is one of the primary challenges facing Medicaid patients today who wait weeks to schedule primary care appointments and even longer to see specialists.

One reform is to repeal our state’s byzantine certificate of need law, which requires health care providers to obtain government permission before opening a new facility, expanding an existing one, or even adding new equipment. This bureaucratic control over health care reduces the number of medical facilities and increases costs, both of which restrict patients’ access to care.

A recent study by the Mercatus Center illustrated the harmful effects of these laws. States with CON laws have on average 35 percent fewer hospital beds per 100,000 persons than the national average. In a county like Miami-Dade, for example, this equates to 3,428 fewer beds. CON laws were also found to limit the number of hospitals with MRI and CT scans as well, which can result in longer waits and higher costs.

Other patient-centered reforms abound that will lower costs and increase access to health care. For example, legislators can expand the “scope of practice” law, which would allow highly trained nurse practitioners to treat common ailments. They also can allow the use of telemedicine and remove regulatory barriers to common prescription drugs. These easily achievable changes will provide additional relief for Florida’s neediest. These changes, along with many others, show there are other ways to deliver high-quality, accessible and affordable health care to 1.1 million Floridians without expanding a federal entitlement program that has been proven to contain more ills than cures.

Chris Hudson is the Florida state director of Americans for Prosperity.


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