The University of Alaska’s Institute of Social and Economic Research (ISER) completed a study titled “Improving Health Care Access for Older Alaskans” in June 2010. This study was authored by Mark A. Foster and Rosyland Frazier. The report addresses the current status of access of Alaska seniors to health care and potential solutions to this access. It also describes the impact of Medicaid on Medicare seniors. This is especially important today due to the increased pressure on legislators to expand Medicaid to a new eligible population. Here is an excerpt to the report relevant to Medicaid (emphasis added):

“The Future”

The problem of limited access to primary care among older residents isn’t confined to Alaska, but it seems to be more acute for Alaskans, especially in the major metropolitan area of Anchorage (as we noted at the outset of this report). This issue is important in Alaska and nationwide not only for those already 65 or older but also for the many more who will be turning 65 as the huge generation of baby boomers ages into the Medicare system. The U.S. Census Bureau projects that the number of Americans 65 and older will increase about 35% in the next decade, up from about 40 million to nearly 55 million. In Alaska, the growth is expected to be even more dramatic. The Alaska Department of Labor projects that the number of Alaskans over 65 will nearly double in just the next 10 years. And over time, the next generations of Alaskans and other Americans will also be reaching the age when they expect to use Medicare as their health insurance. Next we examine why access to primary care has become such a problem for so many Medicare beneficiaries . . .

Alaska primary-care doctors who decline to see new patients universally say Medicare doesn’t pay them enough; about two-thirds nationwide also cite inadequate payment. Many doctors in Alaska and elsewhere also cite the complexity of paperwork and fear of audits as important reasons for turning away new Medicare patients—but Alaska doctors are more likely to cite those reasons. And nearly half of primary-care doctors who don’t accept new Medicare patients in Alaska and elsewhere cite as another contributing reason the “high clinical burden” of older patients—that is, older patients tend to have multiple medical problems that are complex and time-consuming to treat. One sign that federal policymakers recognize Medicare may underpay for primary care is a provision in the new health-care reform law that offers a temporary (2011-2016) 10% bonus above standard Medicare rates to primary-care providers—doctors and others—who see Medicare patients.

Why is the Problem Worse in Alaska?

Why is the problem of primary-care doctors’ declining to see Medicare patients more common in Alaska, and particularly in Anchorage? Several things may contribute. All other major health insurers in Alaska pay doctors more for primary-care services than Medicare pays. That includes not only private insurance, but also Medicaid—the federal health insurance program for low-income Americans—and TRICARE, for military personnel and their families. If private insurance pays $1 for common office visits, Medicaid and TRICARE pay about 81 cents and Medicare pays 63 cents in 2009. The federal government sets Medicare payments, and Medicare pays the same nationwide, except for geographic cost differentials. Medicare has divided some states into more than one geographic area, but Alaska has only a single geographical differential statewide. Individual states have some discretion in setting payments for Medicaid because states pay part of the costs. Medicaid payments vary from state to state, depending on how much individual states are willing to spend. In Alaska, Medicaid pays doctors more than Medicare for primary care. In all other states except Wyoming, the opposite is true: Medicare currently pays better than Medicaid—at least as defined by the published reimbursement level for the same procedures.(32) Medicare pays twice as much in some states, and nationwide it pays on average 50% more than Medicaid for primary care (Figure 8). But that picture will change in the future: the new health-care reform law provides for increasing Medicaid payments for primary care to Medicare rates for 2013 and 2014, with the federal government funding the increases.

And although TRICARE payment rates for doctors are typically the same as Medicare rates, that’s not the case in Alaska in 2010. Since 2007, the U.S. Department of Defense has been paying Alaska doctors 35% more for treating TRICARE patients, in a temporary demonstration project to determine if the increase is enough to persuade more private doctors to see them. The demonstration project is currently set to run through early 2011(Read more from “Alaska Seniors Squeezed to the Back of the Bus by Medicaid” HERE)

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