Whether or not Colorado decides to expand its Medicaid program under the Affordable Care Act remains to be seen, as does how a possible expansion would affect local practices.
"It's hard to say if Medicaid expansion would be helpful or totally sink us," said pediatrician Chris Ebert-Santos, who runs the Ebert Children's Clinic in Frisco. "A sudden increase in the number of patients with Medicaid, coupled with a drop in the number of privately insured patients is a concern for many physicians."
Medicaid payments do not cover the overhead - currently, when a patient on the public program is seen, only about 30 percent of the cost of the visit is reimbursed to the medical provider, versus 70-100 percent from most private insurance companies, Ebert-Santos said.
In its recent landmark ruling, the Supreme Court said states did not have to expand Medicaid as Congress had intended. Gov. John Hickenlooper and his health policy staff have said they need to wait to see how expensive Medicaid expansion will be for the state budget before making any decisions.
Sarah Vaine, executive director for the Summit Community Care Clinic, suspects that if an expansion goes through, some providers will have to cut the number of Medicaid patients they see because of the fee-for-service rates, "in which case, people with public insurance, including Medicare, will increasingly start to feel like uninsured folks," she said.
Vaine points to the case of Dr. Marc Shiffman, who recently shut down his practice in Summit partly due to dwindling Medicare reimbursement rates.
"I think there will be a lot more options for people to go from uninsured to Medicaid, or from uninsured to the insurance exchanges," Vaine said. "But it's all going to be a matter of what those reimbursement rates will be like, and which providers will be willing and able to take that insurance."
Recent estimates place the current number of uninsured children in Summit County that don't qualify for Medicaid just below 1,000, Ebert-Santos said, and these new standards will expand qualifications to include the families of these children.
"Are there children out there in Summit County who are not receiving care that could expand our patient base? If so, more patients would lower our overhead per patient," Ebert-Santos said.
But between the Care Clinic and family practitioners in the area, the pediatrician suspects there are few children not already enrolled with a physician.
"Better access could mean more preventive visits for those who could not formerly afford the insurance or co-pays. This could build volume. Improving the reimbursement for two years would help our bottom line, surely, but if it means our insured patients switch to Medicaid it may be neutralized," Ebert-Santos said.
The Community Care Clinic's mission has always been to serve those medically under-served, which historically has been the uninsured, Vaine said. Over time, that could increasingly become people with public insurance who have fewer options in terms of where to go.
"In terms of the expanded Medicaid coverage in Colorado and its impact on High Country Healthcare and Rocky Mountain Regional Health Services, we expect to see a continuing increase in our percent of patients with Medicaid or like coverage," said Rhonda Koehn, CEO of High Country Healthcare, who is also involved in the creation of Rocky Mountain, a soon-to-be Summit medical office accepting Medicaid.
For more than a year, High Country has been seeing a continuing increase in patients with Medicaid or similar coverage because of the down economy, Koehn said.
"We recognize the high cost of health care and its impact and are working to offer options such as more available primary care hours to help our patients control the high cost of emergency room visits," she said. "We will continue to explore options and partnerships in our community to provide access to quality health care services."
The Denver Post contributed to the reporting of this article.