As I read the proposed modifications, the absurdity of the situation made my head spin.

Many of these patients DO utilize the ED routine precisely BECAUSE Medicaid does not pay enough to primary care providers to make it worth their time and medicolegal risk to care for these medically-complex and financially underprivileged patients.  Many of my Medicaid patients tell me that they are UNABLE to find a primary care provider who will take care of them due to their insurance.  Thus, they are unable to get timely preventative care and prescriptions that would keep them out of the ED.

Underrepresented minorities have always lacked access to healthcare and suffered the worst outcomes in the U.S. This problem was made worse in COVID-19 pandemic. Data from Johns Hopkins University shows that blacks are three times more likely to contract the novel coronavirus and six times more likely to die from it than any other racial group. Emergency physicians are the healthcare safety net when Medicaid recipients do not have adequate access to primary care and public health. These minority groups would be disproportionately impacted and suffer disproportionately when critical-access hospitals lose Medicaid funding essential to their survival. 

Minorities in the U.S. disproportionately have higher rates of co-morbidities that increase risk factors for COVID-19 (obesity, lung disease, diabetes, hypertension, and other immune-compromising diseases). Many of those conditions are on the “preventable” diagnosis list.

Now, with this proposal, you would hamstring the financial viability of the only place many of them can go for care?!?!

The diabetic who cannot get a doctor to write his/her insulin presents to the ED in DKA, who can only afford cheap food and not fresh vegetables,  requires thousands of dollars of care just to stabilize them, and you propose to pay the provider $14.98?

The asthmatic who presents in distress, requires oxygen and multiple rounds of life-saving medications and a 23-hour Observation in an overcrowded ED just to make sure they do not suffocate and DIE, and DMAS proposes to pay the provider $14.98 just because it was deemed by some bean counter that the visit was "preventable" in some idealistic rainbows-and-unicorns world?

By the time these patients present to the ED, the horse is out of the barn, the barn is on fire, and the earthquake has caused the cliff it was built on to crumble.  Yet you would only pay the contractor $14.98 to rebuild the barn because the fire was "preventable"?!?!  In what world does this make sense?

Federal EMTALA requires the ED to see AND STABILIZE patients who come to the ED for care.  Beyond the legal requirements, that is just the right thing to do.  That stabilization can cost hundreds or thousands of dollars, but you MUST realize the the ED is damage control.  We are tasked with fixing problems that have already occurred.  We are the EMERGENCY Department, not the PREVENTION Depart.

Such dramatically reduced payments will result in fewer physicians in the ER and much longer wait times, specifically in urban and rural hospitals, which have a higher percentage of Medicaid patients.

Emergency physicians are dedicated to our national mission to promote and strive toward health equity within the communities we serve. Allowing such an unfair policy to go into effect in Virginia would be a significant step backward towards racial equality and social equity.