Bring Doctors, Legislature to the Table on QAAP With our economy struggling and people hurting, a general tax increase is a poor option. But there is one tax change that I believe we should consider: a targeted tax increase that is good policy and justified by its unique features. I am talking about the Physician Tax, or Doctors’ Quality Assurance Assessment Program (QAAP). I support a 2% tax on a doctor’s adjusted gross revenues, similar to what we already do with HMOs, hospitals, and nursing homes, which would allow the state to receive more of our fair share of funds back from the Federal Government. If we raised $150 million with the tax, the feds would give us $350 million, and we would have $500 million dollars to help avoid devastating cuts to Some argue that about half of the doctors in the state won’t treat Medicaid patients who are people that are struggling financially and have no insurance, because the state reimbursement rates are so low that they lose money on each patient. And the budget plan that was recently pushed through would cut those already low rates an additional 8%. The result of that budget will be even fewer doctors taking Medicaid, reducing access to care, and increasing the most expensive care, the emergency room. Dumb, right? If we want to be smart, we could use the half billion the QAAP expansion raises, and increase reimbursement rates to doctors from the low Medicaid rate to the generous Medicare rate. The result would be more doctors participating, increased access to care for the poor, efficient care instead of expensive emergency care, and increased pay for doctors. If about 3% of a doctor’s patients are Medicaid patients, the doc would break even. Any more than 3% and he would make money. If he treats fewer or none, he would actually lose money. Doctors hate the idea of a Physician Tax. I can understand that, and I try to patiently respond to their comments, questions, and outraged objections, because what I seek is an honest evaluation and negotiation on this option. Doctors have many objections and I would submit there are ways to address them equitably if we come to the table together and negotiate instead of just saying no. Have I been successful yet in opening a dialogue with these doctors? Not really. Most just say, vociferously, NO. A few have been patient and reasonable, and have considered the QAAP on its merits, even if they still don’t like it. But the Medical Society, the Doctors’ lobbyist, has just said no. I am now getting “robo-calls” in my district warning my constituents that I want to tax sick people. This is an attempt to intimidate me and other colleagues into turning tail and running. These guys don’t know me. It has the opposite effect. I believe the real objection is that some doctors will not treat Medicaid patients. The public already pays significant taxes to fund Medicaid. Doctors contribute by treating those patients. What is the contribution of doctors who do not treat these patients? The QAAP expansion is a unique option for doctors that could make health care better. Isn’t it at least worth talking about? That is my duty to you, and I will not shirk it.
October 26, 2009 by Senator Michael Switalski
Posted in Health Care
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