As you have probably seen, Anchor Medical will close up shop by the end of June, unwillingly cutting loose 25,000 patients.  They cite their inability

… to hire replacements for our physicians who have retired over the course of the last decade — while costs continue to rise, reimbursement rates make it extremely difficult to attract new physicians to our state

This is the latest serious development in the state’s primary care physician shortage, a shortage that affects even the House Speaker and at one point (possibly still) a prominent reporter (ProJo’s Kathy Gregg in a tweet a couple of months ago).

In short, if you’ve got a PCP, hold on to them for dear life.  If you don’t, you have an issue.  (This contributor is in the latter category.)

Bigger picture, the state’s healthcare system is in trouble.

Let’s inject a moment of levity here by noting the reaction of the state’s Attorney General, who almost reflexively blamed his political nemesis.

“It’s a system going down the drain without any willingness on the part of — principally the governor — to try to stop it,” Neronha said.

Sorry, no, the constitutionally weak office of governor doesn’t have the power to accomplish this alone, either getting us here or getting us out.  Conversely, the governor is also off base when he tells WPRI 12 that this is “a nationwide issue”.  Why, then, has the loss of primary care physicians disproportionately impacted this state?  And speaking of the governor, it is not helpful that he proposes to actually cut Medicaid reimbursement rates and increase taxes on hospitals in his 2026 budget.

Now to the nitty-gritty of the problem.  Medicaid enrollees comprise around a third of the state’s population. Compounding this, the per-patient expenditure is significantly higher.

… the per-patient cost for those in government insurance is more than twice that of the cost for those on private insurance; as of 2019, Rhode Island providers spent on average $11,420 for each Medicare enrollee, $9,230 per Medicaid enrollee, and $4,501 per patient in private insurance.

Adding to the tab, Rhode Island’s elected officials chose to amplify the state’s Medicaid rolls by expanding eligibility under ObamaCare in 2014.  They have also chosen to extend Medicaid to illegal immigrant children and pregnant women.  

Side note: while that link indicates that illegal alien adults are in theory not eligible for Medicaid in Rhode Island, Rhode Island’s application process is awfully broad in the documentation it accepts for an adult “non-citizen” to qualify for Medicaid and all taxpayer-funded programs.

Those are some of the bigger items contributing to the expenditure side of the Medicaid equation.

Now to the funding side.  Anchor Medical, and many, many other Rhode Island medical providers, note that Rhode Island’s “reimbursement” rate is low.  This is because, for years, General Assemblies and governors has … umm, de-prioritized payment of Medicaid services in the state budget.  Badly.  A February op-ed [paywalled] in the Providence Journal by Michael Wagner, MD, President and CEO of Care New England and John Fernandez, President and CEO of Brown University Health, breaks down the stark numbers.

The root cause of this crisis lies largely with Medicaid in Rhode Island. As the public health insurer for low-income individuals and families, it reimburses hospitals and physician groups far less than the cost of care. The State of Rhode Island allocates significantly less funding toward Medicaid than our neighboring states. Rhode Island has among the highest percentage of Medicaid enrollment in New England; and our provider reimbursement rates are the lowest in the region. A hip replacement in Massachusetts is reimbursed up to $7,670 by Medicaid. In Rhode Island, our program reimburses $1,800 for the same procedure. That doesn’t even cover the hip implant itself, which costs about $4,700.

All of this has understandably compelled many doctors to leave for a state where they do not have to … well, lose money to practice.

Bottom line: when a big chunk of medical care in the state is significantly underfunded, as the General Assembly and governors have done for many years with Medicaid, it threatens the viability of all medical care in the state.

A great many legislators and all recent governors have made big promises in this area; many would say, unnecessarily big.  In any case, their budgetary actions – funding – have not come close to matching their words.  Now the state’s healthcare system is experiencing the acute fallout.

There is an open rumor that Speaker Shekarchi has been firmly declining all requests for new or increased spending in the upcoming budget.  That’s good, except the horse is not just out of the barn but at least ten years down the road.  (Pardon the slightly mixed metaphor.)  In other words, the General Assembly and the Governor needed to be much tougher on new spending years ago while prioritizing in the budget what they have promised — or adjusted their expansive promises.

A texter to the Tara Granahan Show on WPRO commented with a tongue-in-cheek paraphrase of the state’s informal motto: Now you need to “Know A Guy” to get a doctor in Rhode Island.

Let’s get this turned around, leaders and legislators.  Find the funding or, far preferably, revise your promises to better align with reality.  Keep in mind, if nothing else, that the state cannot collect revenue from taxpayers who either die from a lack of medical care or decamp to another state to obtain it.

[Featured Image by Luis Melendez via Unsplash]