Medicaid Bridging the Gap? -- How Physicians Could be Responsible for Further Dividing the Healthcare System

 From 2012-2015, I had the privilege of working alongside my mother at an urgent care clinic she owned and established on the south side of Lansing, MI. Her clinic was located within a predominantly low-income, high crime African American community where more than 90% of the patients were either on Medicaid, Medicare, or did not have any insurance at all. Although I was not medically certified to treat any of the patients, the various observations I made while working the front desk exposed me to the overwhelming health disparities and disadvantages that this patient population were forced to make their reality.

    With a population of about 71,000 and approximately 30% of the entire city being on Medicaid, the south side of Lansing has only three physician's offices: Lansing Urgent Care, South Side Medical Center, and my mother's urgent care clinic. Lansing Urgent Care does not take patients with Medicaid meaning they don't treat "poor people." This apparent discrimination towards patients on Medicaid leaves the South Side Medical Center and my mother's clinic to treat them.

    Medical practices refusing patients on Medicaid has been an ongoing and increasingly pressing issue in healthcare. It's no secret that Medicaid has some of the lowest rates of reimbursement for health services but with this being the primary method of insurance in most underserved communities, how can the medical practice established in this area be aware of this statistic yet refuse them as patients?

    While I was working at my mother's urgent care clinic, I remember speaking with an elderly woman who approached the front desk in distress and out of breath because she had almost missed the bus to make her appointment that morning. She lived in Fowlerville, MI, nearly thirty miles away from my mother's urgent and a three hour bus ride due to all the bus transfers and delays along the route. With her primary method of insurance being Medicaid, she struggled to find any physician who would be willing to treat her as a patient, If and when she needed a recommendation for a particular specialist, it was considered futile because it was either the next available appointment wasn't until three more months or as expected, that physician did not take patients with Medicaid insurance.

    This was only one of the countless stories I heard where patients were traveling more than an hour to receive medical care, not able to find to find a primary care physician would take them on as a patient because of their insurance status, or the struggle to find a specialist who accepted Medicaid insurance. Patients using Medicaid as insurance are just as in need of healthcare as those who are on commercial or private plans. This lack of of expanded access to healthcare for Medicaid patients leads to an over-saturation of emergency rooms and urgent care clinics such as my mother's. The purpose of emergency rooms and urgent cares are to treat medical issues that either require immediate attention or are acute enough to where seeing a primary care physician is not necessary. For the most part, these types of medical services will give their patients enough medication to just temporarily treat them with the intention that they will go to their primary care physician's office for a follow up. So, what happens when they don't have one? They continue to go to the emergency room or urgent care on a frequent basis which is the cause of the over-saturation.

    There is clearly no easy fix to this issue, nor is it something that can be changed overnight but my exposure to this ongoing crisis ignited my passion for working in underserved communities and helped me understand how crucial it is to have medical practices like my mother's clinic integrated within these areas.