Reporting from the Examining Room

The New York Times gets credit for going where few bother, into the examining rooms of doctors who see Medicaid patients—and, more importantly, some who don’t.

It’s a story that’s often told at 30,000 ft—how state budget cuts to the insurance program for the poor and disabled have led to a significant drop in the reimbursement rates for doctors who see Medicaid patients. Add to that dynamic the growth in the program that’s come with the bad economy, and the result is doctors who are opting out of the system.

But the Times gets at the tale with some on-the-ground reporting (there really is no substitute) in Flint, Mich., including the harrowing ordeal faced by a cancer patient whose primary care physician could no longer see her because he had stopped taking Medicaid patients.

Dr. Sahouri said that his reimbursements from Medicaid were so low — often no more than $25 per office visit — that he was losing money every time a patient walked in his exam room.

The final insult, he said, came when Michigan cut those payments by 8 percent last year to help close a gaping budget shortfall.

“My office manager was telling me to do this for a long time, and I resisted,” Dr. Sahouri said. “But after a while you realize that we’re really losing money on seeing those patients, not even breaking even. We were starting to lose more and more money, month after month.”

There’s lots more here, including cold hard data on Medicaid reimbursements, cost-cutting measures the state has taken (like eliminating dental, vision, podiatry, hearing and chiropractic services for adults), and the increase in emergency room visits that has followed the decline in doctors participating in the program.

Others are telling the Medicaid story, too. today offers a quick summary of what’s getting written around the country.

And in the Journal’s survey of what governors are seeking from Uncle Sam, Medicaid is high on the list.

Among other things, Illinois is hoping the federal government will keep paying a higher share of Medicaid costs. “That’s $600 million we desperately need,” said Kelly Kraft, a spokeswoman for Democratic Gov. Pat Quinn’s budget office. Those funds already are counted in the governor’s budget proposal.

But what distinguishes today’s Times treatment is the very real people it includes, like that cancer patient, who still hasn’t found a new doctor, and another woman, who skipped work and drove for hours so a specialist who takes Medicaid could examine her 8-year-old son.

Later this month, she will take the predawn drive again so Dr. Mukkamala can remove her son’s tonsils and adenoids. “He’s going to have to sit in the car for three hours after his surgery,” Mrs. Brown said. “I’m not looking forward to that one.”

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Holly Yeager is CJR's Peterson Fellow, covering fiscal and economic policy. She is based in Washington and reachable at