Your Patients May Lose Health Insurance: Here's How to Help

Medscape

4 days ago

Medicaid cuts are coming. Over the next decade, nearly 12 million patients may lose their health insurance due to steep Medicaid cuts in a US budget package recently signed by President Donald Trump. Another 5 million could lose their Obamacare insurance because of policy changes in the legislation, according to the Congressional Budget Office.
The projected consequences are dire: Hundreds of thousands of people will forgo preventive screenings, and an estimated 2 million patients will lose their primary healthcare providers.
US patients change primary care providers for a variety of reasons, such as a job change, but the magnitude of the loss of regular providers due to the federal budget cuts may be unprecedented.
Even patients who express little faith in the medical establishment tend to trust their primary care providers, so losing access to them risks worsening their distrust of the system. Research has linked lack of access to primary care providers to delays in seeking care and foregoing of preventative services, worsening of chronic conditions, and missed diagnoses.
'It's incredibly disruptive,' said Danielle Ofri, MD, PhD, a primary care internist at Bellevue Hospital, New York City. 'It's soul-crushing for a physician to tell a patient they can't take care of them for reasons…they have no control over.'
Yet even in these challenging situations, physicians can guide their patients, including their most vulnerable, through the healthcare options that may be left for them.
Talk to Patients About Insurance
The first thing to do when dealing with potential loss of insurance is to initiate conversations with patients about what may happen, said Sarah C. Nosal, MD, FAAFP, a family physician and the president-elect of the American Academy of Family Physicians.
'The medical community needs to be really bringing the conversation forward,' said Nosal.
Such conversations can be awkward for physicians and patients alike. And some doctors may feel like they are steering toward a politically charged topic that may make them uncomfortable.
'But a patient losing vital medical coverage is not political,' said Nosal. 'This is health, and we need to really encourage all physicians…to open up this conversation irrespective of politics.'
'Take some time to empathize with the patient as to how traumatic it is for them,' said Ofri.
Indeed, it's important to realize that patients who risk losing insurance are already under a significant amount of stress, said Ada Stewart, MD, a family physician in Columbia, South Carolina, and past president of the American Academy of Family Physicians.
Patients may be unable to keep up even with the treatments that they can access, said Stewart, who is no stranger to seeing patients lose coverage; her state didn't expand Medicaid. Her experience taught her never to blame the patient if they didn't keep up with their healthcare needs, she said, and to welcome back a patient who wasn't able to see her for a time and whose health may have worsened.
Maximize Coverage Before It Lapses
If patients losing coverage are acutely ill, doctors should treat them pro bono at least on a temporary basis even in office settings, said Ofri, until they can secure care elsewhere.
Indeed, the American Medical Association's code of ethics states that doctors have a fiduciary responsibility to help ensure care continuity for their patients. (Doctors in emergency rooms are legally required to stabilize patients regardless of their ability to pay.)
However, 'asking physicians to treat all these patients pro bono is not a solution, it's a Band-Aid for a flawed system,' Ofri said.
When patients don't have acute or urgent needs, the priority is accessing as much care as possible before losing insurance. 'While people still have coverage, making sure that they're up-to-date on all of their preventative healthcare measures is one of the biggest things because it's such a big expense,' said Nosal.
Doctors should advise that their patients schedule mammograms, colonoscopies, pap smears, and basic blood work as applicable, as well as any appropriate screenings for their age and existing conditions. 'Also, make sure their vaccines are up-to-date,' said Stewart.
For patients with chronic conditions, doctors should recommend that they fill ongoing prescriptions before losing coverage, getting the longest course their insurance will authorize.
They also should encourage patients to research whether any pharmacies, including online, offer discounts on their medications paid out of pocket, so they have a plan on where to get them once they are uninsured.
Another important aspect is to make sure the patients have an accurate understanding of any conditions they may have, as well as a good record of their treatments, test results, and diagnoses. While electronic records are becoming better and more easily accessible, printing them out for the patient is best, especially because patients may not have access to a phone or computer, said Stewart.
'Don't send patients through the medical records Olympics trying to get copies of their records. Just give them copies,' said Ofri, who suggests patients keep printed copies of their medication list, test results, and after-visit summaries from their previous five visits.
Nosal said she routinely does that for her patients, printing out after-visit summaries, medication lists, and any results of tests such as ECGs. She encourages her patients to keep a physical file with all their medical records, should they be unable to access digital ones.
Help Patients Find Resources
Doctors and clinics also can help their patients by guiding them toward resources available to uninsured individuals, such as federally qualified health centers.
Medical practices can 'put together a list of all the free services or the services that use a sliding scale and at least provide some direction,' said Ofri, adding this effort shouldn't fall on individual doctors but on organizations such as state medical associations.
Some government health systems, like New York City's, are preparing resources to offer to Medicaid patients at a risk of losing coverage.
Clinicians can help their patients verify whether they qualify for aid and are up-to-date on the necessary paperwork. This often means assisting patients with some bureaucratic tasks too, such as guiding them through filling out applications.
While necessary, all this support comes at a cost. '[It] takes people away from caring for the individual, and so it can be a hindrance for the overall care and for the practice in itself,' said Stewart, adding that it is yet another way in which Medicaid cuts end up affecting quality of care. 'It really takes a toll on our offices,' she said.