Mayo Clinic CEO John Noseworthy said during a speech to employees the health system will prioritize patients with private insurance over those with Medicaid if they seek care at the same time for similar conditions, the Star Tribune reported.
Mayo Clinic has experienced recent growth of 3.7% in the number of Medicaid patients it treats and the health system’s uncompensated care costs associated with Medicaid patients has increased from $321 million in 2012 to $548 million in 2016.
- “If we don’t grow the commercially insured patients, we won’t have income at the end of the year to pay our staff, pay the pensions, and so on,” Noseworthy told Mayo Clinic employees.
The decision by Mayo Clinic to put privately insured patients ahead of Medicaid patients will likely fuel debate over access afforded to low-income individuals covered by the public health plan.
Medicaid critics argue doctors are less likely to accept new patients with Medicaid than with private insurance and that Medicaid patients typically have worse outcomes than privately insured patients. Avik Roy, a conservative health policy expert and president of the Foundation for Research on Equal Opportunity, collected evidence to back up these claims in a February report for Congress. “Access to a robust market for private coverage could significantly improve health outcomes for the poor, without increasing federal spending,” Roy wrote.
Arguments from the other side of the debate suggest that, even if Medicaid patients have less access and experience worse outcomes than privately insured patients, the public health plan is still better than no health plan at all. However, Roy claims in his report that Medicaid patients generally fare “no better than those with no insurance at all” when it comes to health outcomes.
While Medicaid critics can point to a body of evidence that lend credence to their arguments, Medicaid defenders can do the same. Several recent studies and surveys show high levels of satisfaction among those covered by Medicaid and similar levels of access to healthcare that privately insured patients enjoy.
Research published February 27 by JAMA Internal Medicine suggest appointment availability for Medicaid patients has actually increased since Medicaid expansion was implemented. Another study published online in August 2016 by JAMA Internal Medicine suggests Medicaid expansion has encouraged more patients to seek preventive care, to receive regular care for chronic conditions, and to take medications as prescribed. More than 70% of Medicaid patients have rated their coverage as good, very good, or excellent over the past three years, according to the Commonwealth Fund Affordable Care Act Tracking Survey.
Medicaid expansion occurred less than four years, which means researchers looking into its effects on access and outcomes have limited data available. However, the decision by Mayo Clinic indicates Medicaid expansion has placed additional pressure on health systems. Depending on how healthcare reform plays out, more health systems could follow the example set by Mayo Clinic.