For the Sake of their Constituents, Congress Should Increase Medicare Payments and Oppose Deep Cuts to Medicaid

As an Otolaryngologist practicing in the Bronx, New York, I see firsthand the effects of poor access to care — advanced cancers that should have been caught earlier with surveillance and have now become incurable, and inadequately treated conditions like hearing loss or dizziness that can tip the scales from employable to unemployable. I look all around me and wonder if this will be the year, due to the proposed cuts by Congress, that forces the closure of the primary care or cardiology office down the block.

Drastic cuts to Medicaid and Medicare proposed by Congress will increase wait times, result in more fragmented or nonexistent care, and cause unnecessary deaths and despair.

Health care is a human right, and the lack of access to health insurance coverage means that many will not seek care until their health becomes so compromised that they must seek emergency care. The problem for many rural communities is these cuts will shutter hospitals and emergency rooms, leaving patients with no place to go. It will mean hours spent on the road seeking care with a suffering loved one in the back of an ambulance or in the passenger seat.

As physicians, our obligation is to care for those who need us — sick children, the disabled, seniors in nursing homes, veterans, those with chronic conditions, mental health and other special needs. Providing care to our patients is the reason we went to medical school and spent years and years in residency and fellowship training. The thought that these cuts will prevent our patients from accessing needed care is deeply troubling to us.

The enormous potential cuts to Medicaid funding as proposed in the House and Senate reconciliation proposals will disproportionately harm at-risk and rural communities by creating significant new reporting and administrative burdens for confirming eligibility that will likely cause many to lose coverage. It will unfairly penalize states that have chosen to spend their own dollars to expand access to care for persons living in their state, and it will greatly harm the stability of our community physician practices by creating new co-pay obligations on countless patients with limited financial means to pay for care.

In many states, including New York, the majority of children rely on Medicaid for health coverage. The same goes for many families in rural areas where people are more likely to be uninsured and face challenges in accessing much needed health care. Medicaid covers more children and adults in rural communities than in urban areas. It also provides economic security to low-income working families who cannot afford coverage or whose employers don’t provide it. Rural health care is already in crisis across the country and these cuts will worsen the rural hospital and nursing home closures and the access to care challenges as more providers are forced to leave. Cutting waste, fraud and abuse and being good stewards of the taxpayers’ money is in everyone’s interest — including NY physicians — but this goes too far, too fast and without sufficient time to adjust to a new normal.

It was bad enough that the House-passed reconciliation proposal would impose draconian cuts to New York’s Medicaid program and threatens to cause millions to lose health insurance coverage and access to care. Now the US Senate plans to double down on the harm to our healthcare system. They want to cut Medicaid even more and go after our seniors by not addressing the devastating Medicare cuts imposed on physicians over the last several years. At least the House bill had started to address this profound problem, by tying payments to medical inflation. 

We are deeply frustrated that Congress will not provide something as fundamental as full inflation-based adjustments to physician payment, as is standard for Medicare Advantage and hospitals. By implementing years of cuts while inflation and health care costs have soared, the Medicare system has become fundamentally broken. Over the past 24 years, Medicare physician pay has declined nearly 33%, while the cost of running a medical practice has increased by 60% due to inflation and skyrocketing costs.

Hospitals get an inflationary adjustment. Even Medicare Advantage Plans reported to be under criminal investigation get an inflationary adjustment. But physicians keep getting pay cuts year after year — for the past 20 years.

Is it any wonder that physician wait times are going up, and private practices are closing? Congress needs to focus its precious resources on adequately funding physician and provider payment so we have the resources to prevent the progression of disease before it results in an expensive hospitalization, promptly fix an injury so that individual can go back to work and avoid disability, and restore hearing or other accommodations to restore an individual’s employability and with it their self-esteem.

The physicians of NY serve to improve the health and well-being of all New Yorkers. We look to Congress to ensure adequate funding.

Photo: alexsl, Getty Images

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