Last Saturday, June 3, we ran a letter to the editor from Judy Scott who expressed her approval of Congressman David Valadao’s vote in favor of the American Health Care Act and her hope that it will lower costs for people currently on Obamacare.

On Wednesday we received a press release from Congressman David Valadao’s office stating that Valadao, together with fellow California Congressman Jeff Denham, had introduced legislation to “correct California’s flawed Medicaid reimbursement method.” The press release went on to state that California’s Medicaid (known as Medi-Cal here in our state) reimbursement rate currently ranks 48 out of 50 states.

Valadao was quoted in the press release as saying: “Here in the Valley, we know all too well that possession of an insurance card does not equate to health care services and medical treatment. By correcting California’s reimbursement method, we can encourage medical professionals to not only set up their practices in the Valley, but to provide medical services to all patients, including those who rely on the Medicaid program.

“While the American Health Care Act addresses the issue of rising premiums to stabilize our nation’s healthcare system, we must also address the core issues that prevent patients from being able to find and keep a doctor who will accept their coverage”

Representative Jeff Denham (CA-10) stated, “California’s low Medicaid reimbursement rates only exacerbate the Central Valley’s existing doctor shortage.”

We wanted more details so we requested a copy of the new bill, which is officially titled H.R. 2779. Congressman Valadao’s office sent us a copy.

We still had questions so we emailed them to the Congressman’s staff. Below are the questions we asked followed by the answers we received.

Q The bill sounds like it calls for a study to be done but not for any measurable action.

A This is a pilot program, which studies the most effective way to improve payment models to help recruit and retain physicians to serve low-income individuals in the 21st Congressional District.

H.R. 2779 doesn’t specify which models must be tested, however, it does suggest the use of payment rates for physicians’ services that are not less than Medicare payment rates, allowing Federally Qualified Health Centers (FQHCs) to contract with specialty physicians to be paid at FQHC rates for services rendered in the physician’s office, as well as the use of Primary Case Management, Medical Homes, and Palliative Care as potential payment strategies.

The goal of the pilot program is to determine which strategies improve access, outcomes, and patient satisfaction for low income individuals in high Medicaid population areas (such as the Central Valley) and reduce emergency department visits by such individuals

H.R. 2779 requires evaluation of the pilot program to see if these models can be applied nationwide to improve access to physician’s services for low-income individuals.

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Q Studying how to recruit and retain physicians to serve low-income individuals is commendable but it doesn’t equate to getting the state of California to kick in more money so we can pay doctors more via Medicaid.

A You are correct. Governor Brown determines the reimbursement rate for Medicaid for the State of California. This is why it is absolutely critical for Governor Brown to act on the results of H.R. 2779 as they apply to California’s rural regions. It is also imperative Governor Brown doesn’t steal the $1.2 billion from prop 56, and instead ensure the money is used for improving Medicaid reimbursement rates, respecting the wish of voters.

Q It seems like any real benefit for low-income individuals and families in the 21st Congressional District would be difficult to predict and if there is a benefit it would be a long way off.

A It’s not a matter of predicting, the study will confirm which payment strategy leads to the highest level of health care access and patient care. From there, the potential benefits of implementing that strategy will be clear.

Will the American Health Care Act lower insurance premiums for us here in Congressional District 21? And will David Valadao’s H.R. 2779 eventually help Medi-Cal patients here find and keep physicians?

Right now we don’t know. But we all have to agree with Judy Scott—we hope so.

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Does new bill fix state Medicaid reimbursement?