Mr. Obama Has Some Reading to Do

By Suzanne Berman, MD

The Obama administration recently announced plans to use a series of “mystery shoppers” to see whether it’s true that patients with Medicaid have problems getting appointments with doctors.

This isn’t just idle curiosity; Medicaid patients are supposed to get care equal to privately-insured individuals. The equal access provision of the Medicaid Act, 42 U.S.C. § 1396a(a)(30)(A), states that:

“A state plan for medical assistance must . . . provide such methods and procedures relating to the utilization of and the payment for, care and services available under the plan to assure that payments are consistent with efficiency, economy, and quality of care and are sufficient to enlist enough providers so that care and services are available under the plan at least to the extent that such care and services are available to the general population.”

While I’m pleased to see that someone at the federal level appears to be paying attention to Medicaid access problems, this initiative wasn’t all that novel, and in fact seems downright redundant: for years, doctors have been documenting the difficulties with Medicaid access in peer-reviewed medical journals.

About ten years ago, pediatrician and AAP president Steve Berman published a study that documented that, nationally, children with Medicaid indeed had much poorer access to private pediatricians than their privately-insured counterparts. Based an excellent cross-sectional survey of private pediatricians nationwide, its results were impressive for their comprehensiveness; the conclusion wasn’t that surprising or novel, even in 2002.

Since then, the Medicaid/private insurance access to appointments disparity has been studied broadly, again and again – with strikingly similar results every time. Just a few of the studies conducted within the past decade (many of which have even used the “mystery shopper” technique) include evaluation of:

Even yours truly at Survivor: Pediatrics compiled a survey of Tennessee pediatricians showing that Medicaid-insured children in Tennessee do not have the access to pediatricians enjoyed by their privately-insured counterparts.

A few days after its announcement, the Obama administration announced that it was cancelling its mystery shopper initiative. Hopefully, someone decided that re-inventing the wheel wasn’t necessary after all.

Suzanne Berman is a practicing general pediatrician in rural Tennessee. Her study of Medicaid access was supported by a grant from the American Academy of Pediatrics’ Community Access to Child Health (CATCH) program.


2 thoughts on “Mr. Obama Has Some Reading to Do

  1. I’m not sure what the Obama Administration hoped to prove with this misguided “research” program. Did they want to show there is an access problem? We know this from the studies Dr. Berman presented. If a pediatrician chooses not to participate with Medicaid, then they would not be accepting any appointments from patients who are covered through Medicaid. That’s a no brainer. Or, were they trying to prove some sort of discrimination? That is, the pediatrician is participating with Medicaid, but still delays (no openings) or refuses the appointment (has a closed Medicaid panel for new patients).

  2. It must be hard to be the President…expected to know everything about anything before speaking openly about a concern or a problem.

    Wait…it’s hard that way for us pediatricians, too, every day! So I feel for you Mr Obama. My compliments to you that once you realized your oversight, you were quick to turn the boat around. Now…about how to improve access: just pay pediatricians more equitably, and we can afford to care for more children insured with Medicaid.

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