EDITORIAL: More funding needed to serve Quest patients

June 23--Finding a primary care physician who accepts new patients can be a daunting task, even for those who are privately insured. So imagine the difficulty that Quest patients face -- especially now that Kaiser Permanente Hawaii has closed its doors to new Medicaid enrollees.

It's no mystery why Medicaid patients are being turned away. The federal government doesn't fully reimburse the cost of caring for low-income patients, the aged, blind or disabled. Quest, the state's version of Medicaid on Oahu and Maui, essentially shortchanges providers, forcing them to limit the number of new enrollees to remain sustainable.

It's unfortunate but understandable why Kaiser, the state's largest health maintenance organization (HMO), will no longer accept new Quest patients -- having gone beyond its limit of 25,000 Medicaid enrollees to its current 31,500. "If a government payer doesn't pay enough, people can only take on so many of those patients," said Kaiser spokeswoman Laura Lott.

Doctors in private practice have long complained about the low reimbursements, and Kaiser's experience has been no different. Ironically, while many local providers are refusing to take on more Quest patients, the federal Affordable Care Act has produced even more enrollees.

The state and federal governments must find a way to increase reimbursement rates if it expects physicians and HMOs to continue providing care for Medicaid patients. With so many health care providers refusing Quest patients, soon the only option will be to receive care at community health centers, which do solid work but are limited in the services they provide.

Hawaii does not want to follow in the footsteps of California, which is grappling with an over- reliance on Medicaid that negatively affects health-care quality and access. A recent Forbes article said the median wait time to see a health care specialist under Medicaid in California is 20 days, but even more disheartening is research that reveals Medicaid coverage fails to make enrollees any healthier than the uninsured.

Emmanuel Kintu, CEO and executive director of Kalihi-Palama Health Center, said community health centers are having to fill in the gaps when other providers aren't able. As a result, those centers will require more grant support to ensure Quest patients receive adequate care.

Compounding the issue is that there are simply too few physicians who treat patients -- Medicaid or otherwise -- across the state. Hawaii needs an additional 450 primary care doctors to meet its residents' needs, according to the Hawaii/Pacific Basin Area Health Education Center -- a staggering number that requires more vigor and vigilance in recruiting and retaining doctors, especially general practitioners.

High schools across the state need to encourage and mold students for early acceptance programs at the University of Hawaii John A. Burns School of Medicine. Such programs give high school graduates the opportunity to pursue a medical degree and encourage applicants to serve in Hawaii upon completion of medical training.

Clearly, drastic changes are needed so that Hawaii physicians -- affiliated or not with HMOs like Kaiser -- are better able to take on Medicaid patients. To do nothing will only lead to overburdened community health centers and frustrated Quest enrollees with scant care options.

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