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As a general rule, I try to stay away from political issues on this website. However, this is a website all about the finances of high-income professionals, particularly doctors, and this “political issue” directly impacts physician finances. I just spent my day, in-between night shifts, at a conference where some of the details of a plan that is being worked out behind closed doors have come to my attention. Let me give you some background information so you can understand the issue and why I think it is important for every reader of this blog, whether they live in Utah or not.
Utah, like some other conservative states, has not yet taken money from the federal government for ACA expansion. Obviously, since this is our money (last I checked I definitely paid a significant amount in Obamacare tax,) that's kind of stupid not to get your own money back. Medicaid expansion, at least starting in 2017, is paid for 90% by the federal government and 10% by the states. (until 2017, it's 100% by the federal government.) In Utah, Medicaid expansion means providing Medicaid for single adults up to 100% of the poverty line ($23,834 in 2015 for a family of four in Utah.) Children and adults with children up to 100% of the poverty line are already covered by Medicaid here. Families from 100% to 138% of the poverty line qualify for a 100% subsidy on a standard PPACA plan. So there is no doubt this expansion is a good thing for patients, doctors and hospitals (who are now often seeing these patients for free,) and for society at large who now has a better safety net underneath them in case of financial catastrophe.
The Gang of 6- Image courtesy of ABC 4
The Background
There were two competing plans in the Utah legislature this last session to get that money (back.) One passed the house but not the senate. The other passed the senate and not the house. So since the session ended six months ago, a “Gang of Six,” including the Governor, Lt. Governor, the sponsor of each of the bills (including a senator who is an emergency physician and one of my partners in another division of our group), the senate president (the senator in my district,) and the speaker of the house, has been working to find a compromise that will get through the senate, the house, and past the governor. Each of these men are good people wrestling with a difficult issue trying to balance conflicting priorities. Due to constitutional constraints, Utah cannot deficit spend, so not providing revenue to pay for this isn't an option. The “Gang” is also, to a man, like Utah, very conservative and anti-tax, so increasing the general tax rate (i.e. raising income tax on everyone) is not going to be very politically popular. So they have come up with a working concept/principle that “that those who will benefit from this expansion should be asked to give a little back in order to pay for it.” That sounds nice, doesn't it. It actually sounds more Marxist than conservative, which is part of the reason their proposal has surprised me so much. Here's what they mean:
They're going to tax hospitals and doctors to pay for it.
Literally. That's the plan. I was so appalled when I first heard about it way down in the opinion section of the local paper that I wrote a letter to the editor. How do you just tax doctors? Well, you do it by raising their licensing fees. However, it wasn't until today that I found out just how much that tax was going to be. By way of reference, in order to be a doc in Utah, you've got to pay your $200 fee, plus (for most of us) $731 for a federal DEA license and $100 for a state DEA license and if this is your first year applying, you also need to pay the $350 FCVS fee. The license fee in other states range from $130 in Wisconsin to $1002 in Texas and $1300 in the Virgin Islands, some of which require the FCVS fee and some of which do not.
$5,000 Physician Licensing Fee!
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So what will the new fee in Utah be? Well, the number being floated around by the Gang of Six is between $12.5M and $17M per year. Divide that by the 6091 doctors in Utah, and it comes out to $2,052-2,791 per year. Since your license is good for two years, your licensing fee is going to be something like $5K.
$5,000 to practice medicine! That's every doctor in the state. It won't matter if you work part-time. It won't matter if you take Medicaid or not. It won't matter if you only do volunteer charity work (how long are you going to do that when it costs you $5K a year to do so?) It won't matter if you're in primary care or the narrowest specialty. It won't matter if you're an emergency physician and already seeing 20-40% self-pay (i.e. no pay) patients. $5K or go somewhere else.
If this law is passed with this provision in it, Utah will become the only (or should I say the first) to place a direct tax on physicians. Now, you may not think this applies to you because you don't practice in Utah and don't ever expect to. You may not think it applies because you're not a physician (although be aware they seem to be considering including anyone else who gets Medicaid dollars- including pharmacists, occupational therapists, dentists, physical therapists, psychologists etc.) But keep in mind this famous quote from Martin Niemoller about Nazis that is often used to describe a slippery slope:
First they came for the Socialists, and I did not speak out—
Because I was not a Socialist.Then they came for the Trade Unionists, and I did not speak out—
Because I was not a Trade Unionist.Then they came for the Jews, and I did not speak out—
Because I was not a Jew.Then they came for me—and there was no one left to speak for me.
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A little dramatic? Sure. And perhaps just the usual application of Godwin's law any argument eventually arrives at. But the fact remains that if it passes, this will be the first time a single profession has been, well, singled out for a tax. This is the equivalent of taxing construction companies to do highway work or taxing attorneys to improve the courts. These senators seem to think that since we'll be getting a “windfall” (never mind that we're exactly the same people paying the PPACA taxes that fund 90% of this already) we should be the ones who pay the last 10%. There does not seem to be a recognition that this isn't a windfall, since we're actually doing work to get this money. We just happen to be currently doing it for free either due to an unfunded federal mandate (EMTALA) or out of the goodness of our hearts.
Don't think for a second that your state legislature isn't going to look at what happened in Utah when it starts looking for a way to pay for the Medicaid expansion it has already authorized (at least our legislature is considering the costs a priori where many other states just implemented it without a plan to come up with their 10% starting in 2017.) Physician-specific taxes may soon be coming to a state near you. Utah might be the first, but if it passes here, I can assure you it won't be the last.
What Can You Do?
First, if you are a student or resident considering practicing in Utah when you are finished training, you can help these elected officials see how a physician-specific tax affects your decision to stay or relocate here, further exacerbating our physician shortage, especially in rural primary care.
Second, if you are a physician or other professional already practicing here, know that this proposal could very well be law 30 days from now if you don't act. So either contact your leaders, or start revamping your budget to cover this cost.
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Third, even if the only time you'll ever be in Utah is to see the national parks, realize that this isn't a local issue. If this passes in Utah, it will only be a matter of time before a similar proposal is taken up in your state. Just like forest fires are easiest to put out in the first hour, this is the time to take this idea into the corner and drop an anvil on it.
So please, take the time to shoot a short email to one or all of the “Gang of 6” and let them know what you think about this proposed mechanism of paying for Medicaid expansion and specifically about a physician-specific tax/fee/assessment. Please, keep your emails polite as these truly are well-meaning, good people working long hours for little money on this issue, but they need to get the message that taxing a single profession/industry to pay for a bill that will benefit all of society is a terrible idea.
- Governor Gary Herbert
- Lt. Governor Spencer Cox
- Senate President Wayne Niederhauser (wniederhauser (at) le.utah.gov)
- Speaker of the House Greg Hughes (greghughes (at) le.utah.gov)
- House Majority Leader Jim Dunnigan (jdunnigan (at) le.utah.gov)
- Senator Brian Shiozawa, MD (bshiozawa (at) le.utah.gov)
What do you think? Would a $5,000 physician licensing fee dissuade you from practicing in a state? Do you think a tax on a single profession is fair? Do you feel getting paid to see Medicaid patients is a “windfall?” How would you like to see your state pay for their share of Medicaid expansion? Are you willing to email these elected officials? Why or why not? Comment below!
This is just one more reason to have a huge savings rate and get out of medicine sooner.
Every year I see more and more ways to cut our pay. Usually it sits in regulatory jiberish and decreased documentation. Today it’s a direct tax. I just look back 5 years ago and see how much more work I do to comply with this nonsense. Wait until Oct when ICD 10 pops out and then Oct 2016 when we will be paid less by not meeting its documentation requirements.
We as physicians need to ban together and fight back.
I will be sending out an email to the above legislators after this post.
Here’s my condensed letter:
(intro of self) I recently learned that you are considering paying for the expansion of Medicaid in Utah by increasing the taxes/fees on physicians. While I can appreciate the challenges in finding the funding to pay for the expansion, it is a grave error to place this burden on the backs of the healthcare providers.
Forcing health care providers to pay for the cost of Medicaid expansion would have a significant negative impact not only on the physicians but also on the Medicaid patients in our community. There is a misconception that the Medicaid expansion benefits physicians and therefore should be paid by the healthcare community. However, these Medicaid plans do not reimburse providers sufficiently to cover our overhead costs of seeing these patients. We lose money every time we see a Medicaid insured patient. Each year, our group debates whether we should continue to accept Medicaid plans due to the losses we incur in seeing them. Until now, we have continued to see them out of a concern for their healthcare needs. However, if the cost of the expansion falls on physicians, then not only will we be seeing more patients at a loss, but we will also be unfairly paying for their subsidized insurance. We will ultimately be forced to stop seeing patients with Medicaid. The result will be patients that have insurance that is subsidized by the physicians, however, the physicians will not accept this insurance–essentially leaving Medicaid patients without access to healthcare.
I hope that you will recognize that this well-intended proposal would be a very poor decision not only for the providers but, even more importantly, for all Medicaid patients and the healthcare community as a whole in Utah.
Senator Dunnigan’s response to my email:
Thank you for the information and thank you for your service to our community. We have some difficult decisions ahead of us so I appreciate your comments. Just so you know, the Medicaid Expansion plan proposes to reimburse providers at commercial insurance rates, not current Medicaid rates. I don’t expect you to change your concerns about paying for expansion but I wanted you to have that information. I think we have to be careful in our deliberations about if and how we assess providers.
Glad to hear that “if” in there.
I worry about the unintended consequences of the odd proposal to pay commercial rates for taking care of the expansion population, while continuing to pay low Medicaid rates for those who really, really need it (i.e. those who already qualified for Medicaid.) Do we really want to incentivize those taking care of regular Medicaid patients to quit doing that and take care of expansion Medicaid patients (all adults)? The right thing would be to reimburse for all care to Medicaid patients at a higher rate. That would increase access.
I emailed the whole gang! Here’s an excerpt:
To my thinking, taxing only physicians to cover these costs is simply not right. It may seem like low hanging fruit, but I am sure there are other options. Why not increase tax on alcohol, cigarettes, or unhealthy foods? These three factors alone contribute to more disease and therefore more burden on our healthcare system than anything else I can think of. It wouldn’t be as easy as taxing the physician population, as we tend to just put our heads down and grunt through whatever obstacles come our way (it is a vocation for most of us, after all, and we will do it no matter what). But it certainly would be the morally superior choice to make. And isn’t that, after all, what good governance is about?
I think politicians would be encouraged to forge ahead based on you affirming of their beliefs about doctors. Also, I think you mistake the motivations of politicians in general, at the very bottom of their list of motivations is morality.
DONE! Please feel free to copy and use. Don’t forget the part about the MD shortage. It’s real!
I am a practicing physician in New York. I have heard that Utah is considering a physician-specific fee to pay for Medicare/Medicaid expansion. This is both unethical and may well be illegal. I strongly encourage you to reconsider your support for such a provision.
Expansion of healthcare benefits produces dividends for all of society. It is entirely unreasonable that the burden for this expansion should be placed solely on physicians, especially with the current primary care physician shortage. Mandates such as this will encourage more physicians to leave the field of medicine. It would create a dangerous precedent indeed.
Sincerely,
Me, MD, FACP practicing primary care physician in New York, NY
The mistaken premise is that reducing the ranks of the uninsured is a benefit primarily to physicians and hospitals. This thinking ignores the basic fact that the working poor who are presently uninsured will continue to get sick, be hospitalized, need surgery, and need chemotherapy, etc. regardless of their insurance status. When that happens, in addition to delaying getting the needed medical care, they often experience personal bankruptcy, home foreclosure, damage to their credit scores, etc. This has negative effects on the economy as a whole, particularly all of their creditors, which includes credit card companies, landlords, banks, and car dealers as much as it includes doctors and hospitals. This is not some kind of pork barrel special interest payoff. It’s a fundamental societal safety net.
Exactly. The idea that its cost free at the time is ridiculous and demonstrably false.
You point out the federal taxes you have already paid due to Obamacare when that has nothing to do with Utah’s percentage of the Medicaid budget. It seems like you are just realizing the cost of another government boondoggle.
If you want Utah to accept the Medicaid expansion money from the federal government then you should be willing to pay in Utah for that to happen.
We already know that Medicaid doesn’t improve health outcomes https://www.advisory.com/daily-briefing/2013/05/02/medicaid-may-not-improve-health-outcomes so it would seem that physicians and hospitals are the only ones who truly benefit with increased reimbursement.
Prepare to have your money taken and given back to you with a significant handling fee from the government.
Instead of fighting over how to pay for Medicaid expansion in my state I will keep opposing the expansion period. If you support the expansion and they force you to pay for it I have very little sympathy to your plight.
Nothing new here colleagues.
We physicians already have a large tax on our income. It is the difference between what Medicare/Medicaid reimburse vs. private carriers.
A higher license fee will increase the burden of entry to the profession, which favors those inside the profession. The marginals ( part-timers, retirees who still desire a license, moonlighters, volunteers) will drop out of the labor market. This shifts the supple/demand for labor into the favor of those working full time.
The full time employed docs will enjoy a higher demand for their services and can exploit that at contract negotiation time.
WINNERS: full time employed docs.
LOSERS: general public with scarce access, hospitals which pay the employed docs, independent docs who pay their own license fees.
I’m a full time employed ER doc , and would love to see higher barrier to entry to my labor market.
Do most employed docs have their license fees paid by their employer? I was under the impression they do not (we don’t pay for our employees’ licenses.) So while there may be a “win” aspect, it seems there is far more loss whether employed or self-employed.
While I completely agree that a $5000 license fee is ridiculous, medicaid expansion is not a solution. I’m in a medicaid expansion state. ED volumes are through the roof everywhere…and it isn’t sick people. It’s the welfare class, exercising welfare class judgement and you had best do things their way right away lest complaints rain down on the head of administration. Our vets (and I don’t mean the guys who came back from Iraq) have it better right now than we do when it comes to serving a patient population with some sense of self preservation. We are losing physicians, going from 2 advertised openings last summer to 13 this summer. While medicaid expansion may be of some slight benefit to clinic based practitioners who can cap their CMS patient rosters it is destroying EM.
Sounds like the main issue is no clinic-based providers are actually taking those Medicaid patients. It demonstrates that giving everyone “insurance” doesn’t improve access, it worsens it.
Another thing to think about : if people aren’t covered (people who think adding to medicaid is not the answer) do you think they just will stop using ERs? Stop needing health care completely? Suddenly not need their medications? No. Also, why don’t you post back with a perfect budget solution to those who fit into that hole of non-coverage between medicaid and cutoff for ACA. Would love to see that. Not feasible without help from others.
From those who say balking over just a few thousand? Do you know how much medical school is? First, medical students cannot have jobs so all personal expenses go on loans as well. On top of 4 years of personal expenses, tuition is nearing $50,000 a year depending on where you practice and private vs public. In any case, why don’t you pay our 5k extra charges, I’m trying to pay back the 200k loan at 5-7+% interest that started accumulating the day I started medical school. Unreal the government gouges us already. Makes thousands and thousands on us for borrowing us money that they know they will get back. (People with 900 credit score still pay 7% federal loan interest, where else are loan rates that high for perfect credit? NOWHERE)
Since Medicaid in most states does not even cover costs, an expansion of Medicaid does not help most doctors. Other than ER doctors who were treating for free and have no overhead, the rest of physicians lose money on each Medicaid patient they treat. It is not a windfall.
The only reason they were treated is because we are the only profession to be legally mandanted to provide care for free. Also even insurance gets to decide afterwards what they are going to pay you.
Hospitals yes come out ahead. And after this all doctors will be employed by hospitals with less efficiency and more costs.
The end of private practice is near.
I agree with your sentiment but just wanted to point out that ER doctors do indeed have overhead. We have among the highest malpractice premium (depending on which study you look at) and still need to run a business office for contracts/payroll/insurance/complaints/etc/etc. One of the strategies that lawyers and legislators have is to divide doctors amongst ourselves–we need to stick together!
Absolutely, it’s only a “windfall” for us in the ER who are currently doing this work for free. It’s a societal benefit that should be paid for by society at large.
I may have misunderstood this whole situation, but I was under the impression that healthcare costs- not insurance coverage- was the core issue? And if anyone is going to insist that insurance is the only answer- then I’d say we live in a box. A box created by the insurance industry, who has convinced all of us, including physicians, that insurance is the most necessary thing in the universe.
The real problem is cost. And there are certainly more ways of solving that problem which don’t include screwing us all over with more insurance, and the red tape that goes with it.
A few thoughts…
1. The number one driver of healthcare costs is medical equipment and pharmaceuticals. Yet no one talks about it. If we want to reduce costs we should stop looking at the small fish like physician pay, and talk about the big fish. Couple this with tort reform, and we could significantly reduce healthcare costs.
2. Relegate insurance back to where it belongs- major medical/end of life/ major expenses. It was never designed to cover regular expenses. Unless anyone has a car insurance policy that covers oil changes and gasoline- then please, let me know how affordable that is… Also- the cost of healthcare will continue to drop once the third party leeches are no longer dictating how we practice medicine, and taking their share in the process.
3. Dr. Carson has the right idea of giving everyone an HSA, and funding it for those who need it- no gaps, less cost. Plus increased personal responsibility- bonus.
4. Once healthcare costs are reasonable again- return to a cash pay system. Many primary care physicians have turned to this in the wake of the ACA, and they are doing well, as are other sub specialties.
5. Create and support a physician organization that doesn’t sell us up the river for compensation from a new CPT code deal. An organization that actually represents more than 15% of physicians, and works to protect physicians and patients.
Instead of worrying about Utah taxes, why don’t we- physicians- fix healthcare?
That’s a big, complex issue to solve. I agree that the cost of care (and the amount of care consumed) are the big issues. However, I’m working here on a smaller issue that I can actually chew.
Yes, I agree. It is indeed a big issue. But then again, did we go to med school to learn how to place band-aids? I would say becoming a physician is a pretty big bite to chew as well, but we all accomplished it, by starting somewhere. Most of us physicians have resigned to the enormity of the problem of healthcare- and that is why healthcare will probably never be fixed… unless we step up, and start somewhere.
I hope physicians will lead out on fixing the issue. We have better insight into it than most. I’ve considered working on that issue as an unpaid career when I give up what I’m doing now.
Send to the gang of 6. Hope they reconsider their decision
I took time to write to the gang, hope it helps!
Thanks
Dear (Gang of 6)
I am a physician in advanced training in Washington State, and am planning to practice in Florida. I have heard that Utah is considering a physician-specific fee to pay for Medicaid expansion. This is unethical. I strongly encourage you to reconsider your support for such a provision.
Expansion of healthcare benefits produces dividends for all of society. It is entirely unreasonable that the burden for this expansion should be placed solely on physicians. It would create a dangerous precedent indeed.
Furthermore, it would cause yet another burden to be placed on doctors who are facing major issues such as massive student loan debt like mine: over $200,000.00, and I cannot pay all of the interest each month while in fellowship. We also face decreasing reimbursement for the same procedures physicians have been doing for decades, high malpractice costs, costly implementation of ICD-10, major efficiency decreases due to EMR use and others.
Many mid to late career physicians want to retire sooner due to many of these issues. Physicians of lower paying primary care specialties would have a greater impact on their overall compensation percentage should any physician-specific fee be used to help pay for Medicaid expansion. This would be a great negative for any state.
Please consider the whole picture, and I implore you to advocate for the whole medical team that includes the patient, the physician and the payor.
Sent!!
I often agree with WCI, but must disagree with this post. This tax is justified. We physicians get paid what we do because we engage in cartel behavior; we control the supply of the service we offer. It is entirely reasonable for the government to tax cartels.
Despite all of the above bellyaching, medicine remains highly lucrative, especially for those who know how to manage their money There is a reason why the very smartest undergrads continue to fight tooth and nail to obtain a medical school slot.
I suspect most of the pushback is just talk and that the physicians/1000 stat for Utah will not budge if this goes through.
Additionally, as noted by others, the Nazi reference is unbecoming.
Are you a physician? (I suspect not.) How would you feel if a tax for a common benefit (let’s say food stamps) were applied only to your profession?
You have just as much right to apply for acceptance to a medical school as anyone else if it is such an easy path to riches, but personally, I would suggest starting a website instead. It took me 19 years out of high school to get to an “average physician salary” via medicine, but only 4 via a website.
I agree that this individual is not likely a physician. I have never heard of a physician considering him or herself as a member of a cartel or anything like it. In fact, being a physician is nothing like operating a cartel, as most of us have virtually zero ability to control our prices and many of us are legally compelled to deliver service for below cost or free. Name a cartel that operates under those conditions.
This would not be the first time doctors have been targeted for extra dollars. I am not sure if it is still the case or not, but NJ charged physicians extra $100 each time to license or renew to pay for catastrophic uninsured driver coverage for the NJ drivers. I live in Michigan and our state also taxed MEDICAID physicians in form of withholds to expand/pay for the medicaid expenses.
In another form, state has the authority to reduce Medicaid payments, instead of withhold, to every one that benefits from Medicaid and provide/extend coverage to more people. That would be reasonable approach and would directly affect the participating providers in all categories to the extent that they participate. If enough people do not like the idea, then they will drop medicaid participation and limited availability of providers will lead the government to seek alternative solution.
Hadn’t heard about that one. Terrible policy to tax a single profession for a general benefit.
Thanks for posting. Sent this letter to Governor Herbert and other today:
Dear Governor Herbert,
I have always been a supporter of you and your staff. However, this plan to make doctors pay an additional heavy tax to cover Medicaid in Utah is absurd and certainly not consistent with the principles of democracy and capitalism upon which this country was founded. Less offensive taxes resulted in the Boston Tea Party.
Almost all physicians are against Obamacare but since Utah is already being taxed for it we should just as well take the federal funding for patients and protest in other ways. Physicians are underpaid for covering Medicaid patients in the first place and most physician offices are already providing charity work which is an implicit tax on our time. Therefore, charging physicians a surtax to cover Medicaid patients is truly insulting.
I have always trained physicians and other healthcare professionals and they would not be able to afford to come to Utah for training programs for residency and fellowship and they certainly would not want to stay afterwards. Older physicians will retire sooner and those doing charity work only will be forced to quit.
In summary, this is the most inappropriate proposal regarding taxes of our time. There is no precedent for a single group being targeted in this manner. How would the district attorneys and other lawyers like a tax in order to pay for the public defenders that they argue against? Or what about legislators getting a surtax to cover their own salary and government spending? This is an unprecedented proposal and you would lose the vote of many of your most ardent supporters in the state if you proceed further.
Richard L Anderson
Medical Director
AO Surgical Arts
Former Professor and Chief
Oculoplastic Surgery
University of Utah and University of Iowa
1. Licensing fees should NOT be a source of revenue. They should be priced to cover the cost of licensing, which in my state should be basically the cost to maintain records of CME. To use these fees to pay for other initiatives is wrong and DOES represent discrimination against a single class of people.
2. Politicians know that raising taxes across the board is political suicide, that’s why we have tax brackets and tax-break-phase-outs rather than a flat income tax in the first place. Politicians know that the voting welfare class won’t mind at all if the non-voting working class have their taxes raised.
3. This Gang of 6 will not be seen as villains by the general public. They’ll be seen as the saviors who brought Utah’s tax money back to Utah: “Look, they worked on this even though the legislature wasn’t in session, these guys are dedicated! And they cooperated with each other, how refreshing! And they actually managed to get something done, what remarkable men!” Pathetic.
From the UMA’s Call to Action today:
We understand that many physicians have already contacted their legislators to let them know that physicians are not happy with having a physician tax/fee imposed to help pay for Medicaid expansion. Unfortunately, many of these emails are backfiring since they have NOT been very respectful and have attacked the legislators. We would ask you to contact your legislators to respectfully and clearly tell them why you do not believe imposing a physician tax (or licensing fee) to help pay for Medicaid expansion is the right way to go. Simply telling them it is not fair and attacking them, does not work. Attacking them personally, harms the cause.
We understand that the proposal which includes a physician tax (added to the physician licensing fee) will be presented to the House Republican caucus early next week and will be presented to the Senate at some other time shortly thereafter. While we have not seen the final proposal, we have been told the plan is still the Governor’s “Healthy Utah” plan, except it is no longer a pilot program, but a permanent program. We have been told there will be different groups which will be taxed including Hospitals (which had volunteered to pay $25 million per year but are only being asked to pay $17 million a year). Physicians, under the current proposal, would be taxed a total of $12.5 million a year, and others will be asked to pay differing amounts in addition to the hospitals and physicians. We do not know who those other groups are for sure but understand that they include the insurers, the medical device companies and possibly the drug manufacturers. We also believe there are maybe a total of 17 groups/individuals who are being asked to help pay for expansion.
At the UMA House of Delegates (HOD) this past weekend, UMA took a firm position in opposition to taxing licensed individuals to help pay for expansion (We have already been fighting this proposal). The House also voted to continue to support expansion, but oppose expansion if the only option is to tax physicians to help pay for it. If the legislature goes that direction, the resolution that passed the UMA HOD directed that we would try to work with the legislature to convince them to find an alternative to funding expansion.
UMA also recently sent a survey to all physicians in Utah for whom we had email addresses, asking them their stance on Medicaid expansion and the physician tax issue. Two-thirds of respondents support Medicaid expansion and 99% oppose a physician tax.
We ask you to now contact your legislator (find your legislator’s contact information here), and respectfully and clearly tell them, using any of the arguments delineated below (or others if you have more), that this is not the way to fund Medicaid expansion. If you cannot contact your legislator and be respectful, we would urge you NOT to contact your legislator because it will actually harm our fight instead of help our fight.
Please consider using a few of the following arguments when you contact your legislator:
Medicaid expansion helps the people of Utah who are in the expansion class, not the physicians. Physicians really don’t benefit. Many physicians do not see Medicaid patients. Hospitals see a clear benefit from expansion, but if you look at expansion states, there are no studies to show that physicians benefit. In other expansion states, only hospitals (corporations) have been assessed a new tax to pay for expansion, not physicians (individuals).
Medicaid is a “safety net” insurance program provided by the state for low or no-income Utahns and everyone is a beneficiary of that. This program is available for all Utahns if they lose their jobs and need insurance, if they have low income jobs that don’t provide insurance, etc. Expansion should be paid for by the general public, not individual licensed providers who provide a service that the state has decided to provide.
Throughout the many years that Utah has had a Medicaid program, physicians have already supplemented the state budget through a low reimbursement rate that most of the time does not even cover the cost of seeing Medicaid patients. Why should doctors be asked to write out an extra check to help pay for expansion?
Many physicians, under the Affordable Care Act, already pay extra Medicare taxes and business taxes that are sent to the federal government to help pay for expansion, why should they again be asked to pay more for expansion out-of-pocket by actually writing a check to the state?
A physician tax will impact all physicians in Utah, including retired physicians who keep their license to volunteer to work in charity clinics, resident physicians who make just a little more than minimum wage, part-time physicians (mothers and others) who may work only one day a week or a month. This tax will really harm those who are trying to continue providing some type of care to Utahns but will be unwilling to pay for the privilege to do so if a tax is implemented.
Retired physicians provide a great deal of the charity care in the numerous free or low-income clinics in Utah. If they decide to drop their licenses because of a tax/fee on physicians, which we have been told will happen by most of those retired physicians, the patients who are being seen in those charity care clinics will end up in emergency rooms seeking care. That will actually increase uncompensated care and costs in Utah rather than decrease them as expansion is trying to do. Many of the patients who are treated in these charity clinics do not fall into the expansion population and would not be affected by expansion.
The expansion population is composed of adults, not children. However, pediatricians who only treat children would still have to pay the tax under the CMS rule saying a tax has to be broad-based.
If a physician tax/fee is implemented to help pay for expansion and a physician were to work for 35 years in Utah, they would end up paying anywhere from $67,000 (at the low end) to $125,000 or more (could be a lot more if the expansion estimates are not correct and the tax is tied to expansion numbers as we have been told it would be) in a tax just for the privilege of working in Utah over the life of their career. Why would physicians stay in Utah? Why would physicians come to Utah to practice? Physicians already come out of school with an average debt between $125,000 to $225,000 today. Adding an extra fee that they have to pay just to work in Utah will incentivize them to find somewhere else to work, or incentivize those considering a medicine as a career in Utah to choose something else, exacerbating the physician shortage we are already seeing in Utah.
Most physicians in Utah already have full practices; they are not waiting around trying to see if they can serve more Medicaid patients. There is no benefit to these busy physicians.
Imposing a tax or fee on physicians in Utah will cause those who are close to retirement or considering early retirement to pull the trigger, again worsening our physician shortage. We are 46th out of 50 states when it comes to the number of physicians per capita, so we need to keep all the physicians that we already have and not incentivize them to retire early or choose to do something else.
We are willing to work with the legislature to find other ways for physicians to help, and have expressed this willingness, but have been told that physicians will need to pay a tax. Why can’t we work with the legislature to find an alternative solution that physicians are willing to support including, if there are patients who get to participate in private insurance, taking a slight reduction on fees for those who might see these patients.
This could drastically impact the number of medical missionaries for the LDS church who must hold a current license. Many may not be willing to pay a fee to keep a license just so they can volunteer to be a medical missionary.
Please use other personal examples of how this might affect you personally, but again, please be respectful when stating your objections to taxing physicians.
If you are willing to respectfully contact your legislator, please do so this week so that they hear from you before they consider the proposal on how to fund Medicaid expansion. Please pick just a few of the arguments to send to your legislator. Charity care and personal arguments will probably work the best but you can use any of the arguments above.
I sent an email to the governor and Lt. Governor chastising them for even considering this and here was their reply:
September 25, 2015
Dear Loren:
Thank you for your email to the Office of the Governor regarding Medicaid Expansion (funding). I have been asked to respond on behalf of the Governor.
Our office appreciates hearing from constituents and your comments and opinion regarding this issue have been noted. Governor Herbert feels strongly that we must work together to ensure those most in need have access to affordable and quality health insurance. For the last several years, the governor has worked diligently to explore all possible solutions to solve the Medicaid coverage gap created by the federal government. His original plan, Healthy Utah, included an assessment on hospitals but not on physicians to help pay for the plan. It also included a new tax on e-cigarettes to help finance the program. Unfortunately, this bill did not pass the House during the last legislative session.
While the governor has yet to approve a specific funding model, House and Senate leaders are preparing potential legislation to address this issue. The governor has agreed with legislative leaders that those who benefit from Medicaid expansion should also help pay for some of the state’s share of the cost. The key question in his discussions with legislative leaders is who benefits and to what degree. The governor believes that those who benefit the most should help pay the most. While those who benefit very little should pay very little. Some might not benefit at all, and they should not be asked to pay at all.
The governor maintains this must be done in a way that is fair and proportional to any benefit received. Before signing off on any final bill, he will work with the public and industry stakeholders to make sure these principles are upheld.
Thank you for taking time to contact us regarding this matter.
Sincerely,
Alex Conner
Constituent Services
I just can’t even… There are no words.
my letters will be going out momentarily.
How about we recognize the debacle that results from any attempt to utilize funds coerced from the productive members of society for pet projects (welfare, foreign interventionalism, “safety nets,” Social Security, etc., etc., etc.). The current experiment (US Constitution) was only for the protection of individual and property rights and national security. We have strayed IMMENSELY from that original idea, and have a corrupt, bankrupt, leviathan in DC and the Statehouses.
We would be better served by focusing our efforts on completely ending government involvement in the field of medicine.
On Tuesday, October 6, the Utah Legislature’s Health Reform Task Force will be hearing details about a new plan to expand Medicaid in Utah, accepting public comment on it, and voting on a “related” proposal. I encourage you all to be at this meeting.
Tuesday October 6, 2015
3:00 pm at the state capital in Rm W030
I am a 4th year medical student at U of Utah. I was invited to a physician town hall meeting last night in Draper with Rep. Greg Hughes. He held the meeting under the premise of taking physician comment on the new plan.
But, at the end of the day he still plans on including a fee added on to physician licenses to pay for expansion. The number he was floating last night was ~$700/year. But, this fee would rise and fall with medicaid costs; and the fee would be uncapped. When asked point blank if he would vote yes or no on the current plan, he responded with yes.
While $700 beats $2500 (maybe we’re winning here) I really don’t like the whole concept of paying for a general benefit with a licensing fee on a single (or even a few) professions. I suspect you’re the student mentioned on Sermo. Thanks for going to the meeting!
I don’t think the $700 is a win. It’s an estimate, and it will go up as costs undoubtedly will increase. It is an uncapped fee. As costs go up, so will this fee.
Not a member of Sermo (not licensed, yet!). I was mentioned?
I was stopped by a few of the other Representatives in attendance on my way out of the meeting. They gave me the metaphorical pat on the back. However, I got the feeling from all that they still see this as the best idea to fund expansion.
That estimate was $2500 a couple of weeks ago. The fact it’s going down is a great sign. Not a win yet, but less of a loss I suppose.
It was mentioned that a U of U MS4 planning to do FP in Utah but would not if this was put in place spoke up at the meeting. I bet that was you.
We should tax the Church instead. This would provide adequate coverage for the uninsured.
Yes, the solution is clearly to put the burden on a small group of people, as long as that group isn’t me or you, right? 🙂
I am a practicing emergency room physician in Utah. I find the proposal to cover the cost of Medicaid expansion by increasing fees for physician licensing to be alarming. While I agree that everyone deserves access to quality healthcare, funding an expansion in this manner does not make any sense. The physicians who are spending seeing the majority of these low income/Medicaid patients are also the ones who make the least revenue. Consider a physician who works at a volunteer medical clinic. And increase in licensing fees from around $200 every two years to $5000 every two years is very significant. Utah is already suffering from a physician shortage. This is an excellent way to ensure an increasing shortage of physicians in Utah. I belong to a group of women physicians nationwide with over 30,000 members. This is been discussed at length among the members of this group, and the universal sentiment is that this proposal is insanity. Most agree that they would look for jobs in states less hostile to physicians, and choose not to renew their license here if this were to go into affect. Many physicians are in essence small business owners. This is a direct affront to the idea that Utah is business friendly. please reconsider other ways to pay for this expansion.