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ELECTION
IMPACT

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MEDICAID AND MEDICARE IMPACT cians continue to limit the number of Medicaid and Medicare pa-
A special note should be made regarding Med- tients they see.

icaid. Almost 90 percent of the Medicaid popula- Such business changes, however, will result in more complaints
tion in Texas is served by managed care Medicaid. from those who remain covered under government-run programs
With that said, Medicaid is not on the top priority and from those who live in rural areas. The outcry will naturally
list for the Speaker of the Texas House or the Lieu- put pressure on our political leaders to push to expand the scope of
tenant Governor for the 2018 session. Medicaid falls care to non-physician clinicians. More legislation will be proposed
under Article 2 of the Texas budget, which is the to allow non-physician clinicians to practice an expanded scope of
same article under which foster care is funded. Pres- care, unsupervised by the physician. Physicians and organizations
sure to scale back Medicaid will accrue from Federal offering telemedicine will also likely fill the gap, creating potential
cut backs, from the judicial mandate to improve our competition from outside the state of Texas, but also creating an-
foster care system, and from the expected decrease other avenue of opportunity for those with an entrepreneurial streak.
in oil revenue. All of these factors, combined with
one of the most historically conservative legislature in Texas will SUMMARY
make any increase in Medicaid funding highly unlikely. We will ex- In summary, our political decisions are creating a three-tiered
pect that the managed care organizations will receive significantly
less revenue. The resulting financial losses to managed care Medi- healthcare system consisting of a self-pay healthcare economy, a
caid companies will naturally be passed on to physicians, to hospi- private insurance healthcare economy, and a government-insured
tals, and to the patient in the form of decreased coverage of healthcare economy. Although this is not the model we may de-
conditions, pharmaceuticals, and procedures. sire, it is what has been designed with the political choices of both
Democrats and Republicans. This three-tiered system is here to
Medicare will also be affected. Speaker Ryan’s plan proposes re- stay, by default. Once we all understand that this is where we are
placing some of the Medicare coverage with a fixed monetary pay- heading, physicians — with the help of the Texas Medical Associ-
ment to seniors, which would be used to purchase coverage from ation and the American Medical Association — can successfully
private health plans or from traditional Medicare. Coverage of cer- navigate these waters.
tain conditions, procedures, and pharmaceuticals would also likely
be restricted under this change. It is unclear if he can truly push this Dr. Alexander Kenton is a neonatologist who works for Mednax as
through since President-elect Trump has previously voiced support the medical director at Methodist Children's Hospital. He is the cur-
to maintain Medicare in its current form. rent chairman of the BCMS Legislative Committee and the member-
ship chairman for TexPac.
HOSPITALS AND PHYSICIANS
It is estimated by the Congressional Budget Office (CBO) that

22 million people will lose insurance with the last repeal plan offered
by Congress. Regardless of whether this number is accurate, it is
likely that tens of millions of people will have a change in their cov-
erage to something less comprehensive. That will translate to signif-
icant loss of hospital and physician revenue. For those hospitals and
physician groups who rely on insurance or government-run insur-
ance, we anticipate a resulting decrease in investment in resources.
Other methods to sustain financial viability include consolidation
of hospital systems, alignment and consolidation of large physician
organizations, as well as a continued relocation of physicians and
hospitals from rural to urban areas. Patients on Medicaid and
Medicare will likely have less hospital and physician access as physi-

16 San Antonio Medicine • January 2017