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Texas Docs Cut Back On Poor Patients

AUSTIN (AP) – The number of Texas doctors willing to accept government-funded health insurance plans for the poor and the elderly is dropping dramatically amid complaints about low pay and red tape, showed a survey by the Texas Medical Association provided to The Associated Press Sunday before its Monday release.

Only 31 percent of Texas doctors said they were accepting new patients who rely on Medicaid, the health insurance program for the poor and disabled. In 2010, the last time the survey was taken, 42 percent of doctors accepted new Medicaid patients. In 2000, that number was 67 percent.

Texas doesn’t have enough primary-care doctors to serve the size of the state or its rapid population growth. The doctors’ reluctance to take on new Medicaid patients comes at a bad time, since the new federal health care law proposes adding 6 million additional people to the Texas Medicaid rolls with the intent of ensuring every U.S. citizen has access to health insurance. The state ranks last in the nation in terms of percentage of people insured, with 27 percent of Texans without any kind of insurance, according to a March Gallup poll.

Doctors complain that the Texas Medicaid program pays only half of the actual cost of most services, leaving them to absorb the losses. The Republican-controlled Legislature cut Medicaid reimbursements to doctors by a total of 2 percent in 2010 and 2011 and dramatically reduced payments for patients who qualify for both Medicaid and Medicare, the health care program for senior citizens.

“Every business has a breaking point and physicians’ practices are no different,” said Dr. Michael Speer, president of the Texas Medical Association.

The association, which has 46,000 members and is the largest state medical association in the country, surveys 1,000 doctors every two years to assess patient loads. The survey samples a cross section of Texas’ doctors in a variety of specialties and doctor ages.

Doctors appeared to be losing patience with government-funded health care plans in general. The number of doctors accepting new patients who rely solely on Medicare dropped from 66 percent in 2010 to 58 percent in 2012. More than 78 percent of doctors in 2000 said they would accept new Medicare patients.

While the federally managed Medicare program pays better than state-controlled Medicaid, doctors found caring for those patients to be onerous because of the paperwork required.

“All the bureaucratic red tape and administrative burdens only serve to increase the cost of running a practice while diverting a physician’s attention away from patient care,” Speer said. “What’s lost in the health care debate is the simple fact that patients need a doctor when they get sick. And physicians want to take care of patients and not push endless reams of paper around our desk.”

More than 54 percent of doctors said they are not accepting patients in the Children’s Health Insurance Program, a state-run program for poor children. In Dallas County, more than 68 percent of doctors said they would not treat new children who use CHIP.

The association said the state needs to do more to bring in doctors, because many are expected to retire over the next 10 years. Almost half of Texas medical students must leave the state for residency training because there are not enough positions in the state, and studies show most doctors settle where they perform their residency. The association is calling on the Legislature, which funds most residency programs, to fund additional spots to keep students from leaving.

Republican leaders have passed major tort reform laws to bring down the price of malpractice insurance in Texas, but that hasn’t done enough to solve the shortage of primary care physicians. Texas has 72 primary care physicians per 100,000 people in urban areas and only 52 per 100,000 in rural areas. The national average is 128 primary care physicians per 100,000 people.

Catherine Frazier, spokeswoman for Gov. Rick Perry, said the state has made some progress, citing that the number of obstetricians in rural Texas has grown by 27 percent. She said the governor will do more.

“Gov. Perry understands the importance of fostering an environment that encourages doctors to get licensed and practice in our state, and tort reform has been the most powerful tool in achieving that goal,” Frazier said. “Regarding Medicaid, Gov. Perry has long acknowledged the system is broken, unsustainable and in crucial need of drastic reform.”

Democratic lawmakers have said Perry’s demands to cut the budget rather than raise taxes is the reason why Medicaid is underfunded and doctors are dropping out.
The state’s health and human services commissioner has estimated the Legislature will need to find $10 billion in new funds to make up for the current Medicaid deficit and cover future growth of the program over the next two years.

(© Copyright 2012 The Associated Press. All Rights Reserved. This material may not be published, broadcast, rewritten or redistributed.)

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