Despite a shortage of primary care physicians and pediatricians in communities nationwide, I choose to work in New Mexico because I care deeply for my native home. Unfortunately, the state seems to be doing its best to discourage this choice.
My pediatric practice is in a rural area, where four out of every five kids are enrolled in Medicaid — the state/federal health insurance program for the poor. It’s a critical source of health coverage for families, my neighbors and 80 percent of kids who go to school with my children. Most of the children I care for who are covered by Medicaid have parents who work full time. They are teachers, medical assistants, perform seasonal agricultural work or have other local jobs that neither include health insurance nor pay well enough to allow them to purchase it.
The state has made deep cuts to Medicaid over the past two years. Cuts are devastating when Medicaid makes up the majority of revenue for many physicians. The budget cuts have in many ways shifted the cost of care to practitioners. It’s a disincentive for those of us who treat Medicaid patients, and it means we are essentially providing a subsidy to the state in caring for these patients. Our costs have gone up every year, but our reimbursements haven’t. Payment rates to Medicaid practitioners were reduced last year by between 2 percent and 7 percent, depending on the type of care and visit. Even with no decrease to the Medicaid fee schedule, we get a significant pay cut because inflation and our costs continually rise.
Not only that, the state eliminated reimbursement for hearing and vision tests — effectively an additional 5 percent cut for a pediatrician like myself. Cutting this screening is penny-wise and pound-foolish. Vision and hearing are critical to a child’s early development and learning. By screening early and regularly in a child’s life, we can detect and address issues before they grow into costlier interventions down the road. From a cost-benefit perspective, investments in children have enormous payoffs. The state and federal government recoups much of the investments in Medicaid for children in the form of higher future tax payments. Children eligible for Medicaid live longer and are more likely to go to college than those who are uninsured.
I rely on pediatric specialists at The University of New Mexico and Presbyterian Healthcare Services to care for patients, but low reimbursement rates for pediatric subspecialists make it difficult for both systems to attract and maintain these specialists, which in turn adds to delays in getting patients needed care and adds further stress upon a system already on the brink.
The financial burdens and stress on the health care system have become too much to bear for many practitioners who have left the state to practice elsewhere. I, too, receive attractive offers to practice in other states on a daily basis, yet my moving would leave my region of New Mexico with no full-time, board-certified pediatrician.
We’ve reached the point where Medicaid cuts are causing real and potentially long-lasting damage to the health care workforce and the health of all New Mexicans. When the Legislature meets for a special session Wednesday, I urge them to fully fund Medicaid. The issues our state faces require dialogue, compromise and effort to benefit all New Mexicans. We must rise to this occasion.
Dr. Brian Etheridge, M.D., FAAP, is president of the New Mexico Pediatric Society. He practices in Silver City.