The Dallas Morning News

AUSTIN -- Doctors in the Dallas area and across Texas are threatening to opt out of Medicaid because of payment cuts, which would further damage the state's already uneven delivery of health care to the poor.

The 1 percent trim to provider fees that starts Sept. 1 sounds modest. But doctors, insurance industry officials and health care experts widely see it as the first of many hits coming to doctors' wallets as Texas' fiscal woes deepen.

State leaders' instructions for agencies to identify additional 10 percent budget cuts in the next two-year budget cycle mean more fee cuts may come next summer. Experts say further reductions could drive off doctors, dump more patients on hospital emergency rooms and ensure a rocky start for the federal health care overhaul, which by conservative estimates could add 1.5 million Texans to Medicaid by 2015.

The cut demonstrates a potentially recurring problem with budget cuts as state leaders contemplate a shortfall that could hit $18 billion: Cuts that lawmakers make now to programs that are already stretched thin could cause deeper long-term woes.

Medicaid, which covers about 3.3 million poor and disabled Texans, has steadily lost doctors over the past two decades. (Participation improved slightly after 2007, when the Legislature approved fee hikes, mainly for pediatric services as part of a settlement to a long-running class-action lawsuit.) 

According to the Health and Human Services Commission, the program's overseer, only about 15,000 of the state's 48,700 practicing doctors are active in Medicaid. A recent study by Irving-based Merritt Hawkins & Associates, a doctor recruitment firm, found that across five specialties, including obstetrics/gynecology and family practice, the combined Medicaid acceptance rate is just 38.6 percent in Dallas, the lowest in 15 major U.S. metro markets surveyed.

With the state facing a budget shortfall for the next two years of as much as $18 billion, the job of holding together enough doctors to serve Medicaid patients falls to state social services czar Tom Suehs.

Suehs, head of the Health and Human Services Commission, has said he's sensitive to doctors' gripes about low Medicaid payments, even as state GOP leaders order him to scrub programs for savings.

Cross-currents of federal policy complicate Suehs' task. In Medicare, the seniors' program, doctors have faced repeated threats of fee cuts. Last month, Congress staved off a 21 percent cut.

In the March survey by the Texas Medical Association, 33 percent of doctors said that because of the ongoing problems with Medicare fees, they've already limited how many Medicaid patients they'll take. Another 39 percent said they also will or may curtail their Medicaid clientele.

And in 2014, there will be huge new demands for care. The federal health care overhaul will put more poor adults on Medicaid and bring along many children who are eligible but not yet enrolled.

Late last month, while protesting the 1 percent payment cuts, a coalition of doctor groups warned that unless Texas entices more doctors into Medicaid in the next few years, the federal overhaul will become "an empty promise" for millions of Texans.