By Gurdev Rai

This year, the legislative session started with one thing on everyone’s minds: the state budget, and the major hole created by Congress’ HR 1 law. Costs, including for health care, have ballooned across the board, and we know state leaders are looking for solutions. However, as a practicing physician, I find it unconscionable the state legislature has decided to balance the budget on the backs of Medicaid patients by cutting reimbursement rates for the most
critical care.

Anesthesia care plays a pivotal role in health care. The ability to perform lifesaving procedures, including surgeries and maternal care, without severe pain is one of greatest accomplishments in the history of modern science and is now of course essential to the delivery of health care.

Yet year after year, the legislature tries to solve budget crises by cutting Medicaid reimbursement rates across the board, without success. One in four Coloradans use Medicaid, and 40% of Colorado’s children use Medicaid or CHP+.

That’s 1.2 million people who may find themselves unable to access care because so many serious medical treatments or surgeries require anesthesia. It also disproportionately affects lower-income and minority groups, who are already more likely to be uninsured or underinsured. Research shows lack of insurance has a stronger correlation with poor health outcomes than
almost any other factor, including race.

We know what happens when patients don’t have access to the care they need because of cost. They delay health care, or forgo it entirely, regardless of whether it’s preventive, elective, emergency, or long-term treatment for a diagnosed medical issue. Drastic cuts like these hurt patients and providers alike. Cuts like these put government between patients and doctors. I speak for me and many of my colleagues when I say, I hope I will not be in a position to have to recommend care based on what a patient can afford, instead of what I know will lead to the best outcomes for their long-term care.

The Medicaid reimbursements for anesthesia care are already benchmarked to Medicare rates, unlike any other system in the state. That has led rates to remain artificially low compared to other carriers, based on a flawed approach to data. According to a 2020 report, Medicare pays significantly less for anesthesia services compared to the commercial market than it does for
other physician services.

Cutting rates, especially by the staggering amount of 15% across the board now passed by the legislature, causes a ripple effect that undoubtedly leaves the most vulnerable people without access to the quality care they need. This amounts to almost a 50% cut to anesthesia care incorporating a nearly 40% cut from last year. This is completely unsustainable for patients and providers.

These cuts also come at a time when the state agency responsible for managing Medicaid, the Department of Health Care Policy and Financing (HCPF) has come under fire from multiple sources for making improper payments and mismanaging funds. It seems the state could make some improvements internally before looking to cut critical programs like Medicaid.

Anesthesia requires highly trained teams of providers and nurses led by physicians who can provide high-quality care and coordinate to ensure patients stay safe and to reduce significant pain. But providers will not be able to afford working in the state, and physician shortages do result in longer patient wait times and delayed care overall.

It will be difficult for physician practices to remain open, even though they help serve populations where there are fewer hospitals — especially in rural areas, where more than 20 counties’ populations disproportionately rely mostly, or even solely on Medicaid. Three rural counties rely on Medicaid programs to serve more than 50% of their population — in Costilla County, it’s 55%.

Numbers don’t tell the whole story of health care. It’s one thing to look at a budget plan; it’s another to tell someone they or a loved one can’t have the surgery they need because there are no providers in the area, or to force expectant mothers to drive hours to receive adequate maternal care.

We’ve made major improvements in health care access and equity. These steps have helped thousands of people receive lifesaving care they desperately need. We can’t leave Colorado patients and providers behind like this. I am urging the legislature to roll back these cuts, before it is too late.

Dr. Gurdev Rai is an anesthesiologist.