Saying Medicaid is a broken system that should not be expanded in Texas, Gov. Rick Perry and the state’s U.S. senators suggested many physicians decline to serve patients insured by the state-federal program.
In an April 1, 2013, press release issued in conjunction with their joint Texas Capitol press conference, Perry and Sens. John Cornyn and Ted Cruz, all Republicans, said that nationally, Medicaid expenditures surged from 1990 to 2010, outpacing its caseload.
Also, their press release said: "Only three in 10 Texas doctors are currently accepting new Medicaid patients." Elaborating in the press conference, Perry said: "And we fear that number may actually decrease if expansion went through."
The 3-in-10 claim, brought to our attention by analyst Anne Dunkelberg of Austin’s liberal-leaning Center for Public Policy Priorities, sounded familiar, especially after spokespeople for Perry and each senator said by email that it was based on a 2012 survey of Texas physicians by the Texas Medical Association.
Preliminary results from the survey figured into one of our fact checks earlier this year.
Final survey results are now compiled, Donna Kinney, the association’s lead researcher, told us by phone. Kinney said the results break out to 32 percent of Texas physicians saying they accept all new Medicaid patients and 42 percent declining all new Medicaid patients--with 26 percent limiting their new Medicaid patients.
Put another way, the final results indicate that about four in 10 Texas physicians decline all new Medicaid patients while about six in 10 accept at least some new patients. "They may accept them only in the emergency room," Kinney speculated. "The limits could be anything."
Early this year, we rated as Mostly True the association’s claim that only 31 percent of Texas physicians accept all new Medicaid patients, compared with 67 percent in 2000. The group’s Twitter post about the figure was missing clarification that the figure came from a survey.
At the time, though, the Texas Health and Human Services Commission told us that some 67 percent of the state’s physicians had accepted Medicaid at least once during a recent 12-month period. Agency spokeswoman Stephanie Goodman told us by email that 34,290 Texas physicians had claims paid by Medicaid in the fiscal year that ran through August 2011. According to the Texas Medical Board, there were nearly 51,000 practicing physicians in the state at about that time.
Goodman said then that she did not have information on the share of physicians not accepting all new Medicaid patients.
Brent Annear, a medical association spokesman, guided us to a March 2012 web post by the group stating that 27,917 physicians and medical residents were asked to fill out its online survey and the group fielded 1,139 responses, a 4 percent response rate. The group’s "preliminary findings" document says the respondents were a "representative sample" of all physicians. The survey reached members and non-members, Kinney told us by email.
The key question lists physician reimbursement methods including private insurance, Medicare and Medicaid. "For patients covered by the following payers," the question says, "does your practice currently (1) accept all new patients, (2) limit new patients that you will accept, or (3) accept no new patients?"
According to the final results, Kinney said, 32 percent said they accept all new Medicaid patients. Some 26 percent said they limit their new Medicaid patients, and 42 percent said they decline all new Medicaid patients, compared with 32 percent in 2010.
For our previous check, Annear said by email that physicians have difficulties with Medicaid’s rates and bureaucratic hurdles that delay payments. The rates decreased four times from 2000 to 2011, an association spokeswoman, Pam Udall, said by email, though the state also agreed to a 25-percent boost in funds covering certain physician services provided to children on Medicaid, as part of resolving a lawsuit.
We asked Kinney to speculate on why nearly 70 percent of Texas physicians submitted at least one Medicaid claim in a recent year. She said about 60 percent of the state’s physicians--including many specialists in radiology, pathology and anesthesiology--must accept Medicaid to maintain their hospital admitting privileges. Those kinds of doctors would have responded to the survey by saying they limit new Medicaid patients, she said by phone.
For a "real-world" take, we ran the preliminary survey result by Austin opthalmologist Michelle Berger, the 2013 president of the Travis County Medical Society, which is affiliated with the medical association.
Berger said by phone that the society frequently fields inquiries from individuals newly on Medicaid seeking a doctor. Berger said she stopped accepting new Medicaid patients in her practice because related paperwork proved onerous and government payments, which have not kept up with inflation, were not quickly forthcoming. Then again, she said, doctors who do not accept new Medicaid patients may still provide charity care--the result being that some low-income patients are served even though their doctors do not seek payment.
Asked to appraise the Texas leaders’ declaration--that only three in 10 physicians accept new Medicaid patients--Kinney said: "The language does matter. They should have said ‘all’" new patients.
In emails, Perry spokesman Josh Havens and Cornyn spokeswoman Jessica Sandlin each said the leaders’ statement accurately reflected the association survey. Havens added that "you cannot continue to add context to manipulate the result you want." Cruz spokeswoman Catherine Frazier, also standing by the claim, said by email that the point is that Medicaid is a broken system.
Perry said only three in 10 Texas doctors currently accept new Medicaid patients.
In a recent year, some 67 percent of Texas physicians submitted at least one Medicaid claim.
More recently, 42 percent of the state’s physicians responding to a 2012 survey said they refuse all new Medicaid patients. Then again, 32 percent said they accept all new Medicaid patients and 26 percent said they limit such patients--signaling that 58 percent of physicians accept at least some new Medicaid patients.
By not specifying that the cited "three in 10" reflects only doctors who accept all new Medicaid patients, Perry’s statement falls off target by nearly 30 percent. Still, it has en element of truth. We rate it Mostly False.