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OPINION: Medicaid co-pay proposal would reduce access to critical health care



nappa-9912701-7870996Nevada Advocates for Planned Parenthood Affiliates urges the legislature to focus on educating consumers in order to open up access to health and improve health outcomes, ultimately lowering health care costs for everyone.  Requiring Medicaid recipients to pay a small co-pay before they get medical care would reduce access to critical health care, hurt providers and drive up the cost of health care.

Nevada has one of the lowest Medicaid participation rates in the country, not an overutilization problem.[1]  The Medicaid expansion covers individuals and families who earn less than 138 percent of the federal poverty level. That is $15,415 a year for an individual and $31,809 for a family of four.

While a form of co-pay may make sense in the prison system (where inmates do not have to pay for food or housing), even the smallest co-pays would be a huge struggle for these families.

The proposal does not address the administrative cost of creating the infrastructure to collect minimal co-pays, a cost that would fall entirely on health care providers.  Nor does the proposal address the fact that the federal Medicaid law allows nominal co-pays but does not let doctors or providers refuse treatment to those who cannot pay.  Implementation of a co-pay is an additional cut to the provider reimbursement rate since providers are the ones who collect “and keep” the fee.

The Affordable Care Act does hold the promise of bringing health care costs down.  The only way to get there is for uninsured Nevadans to have access to preventive health care – either because they have health insurance or they are covered by Medicaid.  Creating another barrier to health care just continues the costly pattern of patients putting off care only to wind up in the emergency room when they have serious health problems.

The goal of implementing health care reform in Nevada must be access to care.  Rather than taxing Nevada’s lowest income families, the legislature should focus on public health education.  In Massachusetts, families who were newly able to buy insurance needed support in order to understand how to optimize the preventive care options available to them.

If the Legislature is interested in getting the best return on its health care investments, it should focus on helping Nevada families get preventive health care as well as the critical health screenings that offer the earliest detection and most effective treatment of serious health diseases.


[1] http://www.census.gov/compendia/statab/2012/tables/12s0152.pdf

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