Medicare reimbursement rates need fixing, Obama says

McClatchy NewspapersJuly 1, 2009 

WASHINGTON — President Barack Obama said in an interview Wednesday that he'd like to revise the Medicare reimbursement rates that currently shortchange the San Joaquin Valley.

While steering clear of details, Obama indicated that revised reimbursement rates helpful to areas like the Valley should be part of a comprehensive healthcare reform package now in the works. The reforms should also help steer more physicians to medically underserved regions, he said.

"Examining what we can do in rural communities is something that makes a lot of sense," Obama told a small group of reporters, adding, "We've got to get healthcare providers there."

The relationship between government reimbursements, physician availability and the quality of care is a complex one. By almost every measurement, though, the region between Sacramento and Bakersfield has more at stake than most in healthcare reform.

Medicare reimbursements lag, from $8,200 per patient in Fresno and $9,000 in Modesto, compared to nearly $12,000 per patient in Los Angeles. Physicians are fewer and farther between. The San Joaquin Valley has 62 primary care physicians per 100,000 residents, compared to 82 physicians per 100,000 residents in the San Francisco Bay Area.

About 16 percent of San Joaquin Valley residents up to age 64 are uninsured, according to a 2005 Great Valley Center study. By contrast, only 9 percent of San Francisco Bay Area residents are uninsured.

"There are families all across the country that don't have health insurance or are uninsured," Obama said.

Obama summoned nine reporters for a 50-minute conversation in the Roosevelt Room of the White House as part of his effort to rally political support for a healthcare rewrite. The package is still a work in progress, as key congressional committees already have missed their self-imposed legislative deadlines.

Though Obama has invoked an August deadline for getting bills through the House and Senate, the cost and complexity stymie lawmakers. One package favored by some Senate Democrats would cost more than $1 trillion while still leaving millions of people uninsured, the Congressional Budget Office recently estimated.

Democratic Sen. Dianne Feinstein has acknowledged that "there's a lot of concern in the Democratic caucus," and lawmakers are still trying to figure out what their constituents want. In Tracy and Stockton, for instance, Rep. Jerry McNerney, D-Pleasanton, is conducting a "healthcare listening tour" Thursday morning. In Bakersfield, Rep. Jim Costa, D-Fresno, joined about 200 people Wednesday for a healthcare roundtable.

"There are a lot of concerns," McNerney said Wednesday, "but there's a pretty good consensus, in my opinion, that we need to do something that is comprehensive rather than piecemeal."

McNerney added that "there needs to be a frank discussion of how we pay" for the healthcare legislation, although he has not committed to any specific strategy yet.

"Those that have a decent healthcare package are afraid that reform will end up costing them more money," Costa agreed, while he said that "those that have pre-existing conditions, those that are older and those that are uninsured" are eager to see reform that boosts coverage.

One commonly mentioned but politically controversial option would reduce the current tax exclusion for employer-provided health insurance. Though this could raise hundreds of billions of dollars over the next 10 years. Obama seemed to rule it out Wednesday.

"I'm not persuaded," Obama said, adding that "having a radical restructuring ... would end up with significant political resistance."

Obama is letting Congress take the lead in writing the bill, though he insisted that the huge costs should be offset in some unspecified way "so it doesn't add to the deficit."

Costa characterized Obama's time schedule as "ambitious," but he said that "the interest level is high" among constituents -- particularly among healthcare professionals. On Capitol Hill, alternative plans are flying back and forth, including one introduced several weeks ago by Rep. Devin Nunes, R-Visalia.

Nunes serves on the House Ways and Means Committee, which will play a major role in writing a healthcare package. Rep. George Radanovich, R-Mariposa, sits on the House Energy and Commerce Committee, which is the other big committee handling health reform.

McClatchy Newspapers 2009

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