A punitive measure that would fine Medicaid patients who miss doctor’s appointments is unnecessarily harsh and deserves to be vetoed by Gov. Jay Nixon, who has it under review.
There are better and less mean-spirited ways to achieve the worthy goals of trying to get patients to take more control of their health care, and helping doctors avoid the time and money lost to missed appointments.
The bill, SB 608, would allow Medicaid providers to bill a missed appointment fee when MO HealthNet patients miss or fail to cancel 24 hours in advance. The measure was sponsored by Sen. David Sater, R-Cassville. The Senate’s two doctors, Rob Schaaf, R-St. Joseph, and Bob Onder, R-Lake Saint Louis, voted in favor.
This measure has all the hallmarks of being politically motivated and callously dismissive of the financial conditions poor people must endure. It does nothing but punish already struggling low-income patients and make life easier for doctors. Health care experts say it is also unlikely to win federal approval even if Nixon signs it.
The fees in the bill are $5 for the first missed appointment, $10 for the second and $20 for the third. Small amounts but enough of a financial obstacle to discourage people from seeing their doctors altogether.
That’s the dangerous part of the bill. People who live in poverty already have lower life expectancies than those with middle or higher incomes. Erecting barriers to getting health care can only increase the gap.
The bill would also drive up costs for people with private or employer-paid medical insurance plans because the additional expense of caring for a sicker population would be passed on to them.
There are easier and better ways to discourage people from missing doctor’s appointments, including reminders by phone, text or email or flexible scheduling systems that can accommodate potential no-shows.
Patients often have honest reasons for missing appointments and not calling to cancel. Low-income patients often have unreliable cars or live in areas with inferior public transportation. They might not know until they start out, and the car breaks down or a bus doesn’t arrive, that they won’t make their appointment.
There are legitimate debates about whether Americans are entitled to health care, about the quality of care they receive, and how care is paid for. But there should be no debate on the morality of gouging a poor person for a few dollars.
Doctors themselves often aren’t punctual. An appointment goes long or they get an emergency call. Empathetic doctors understand that similar delays happen to their patients. While patients might not confront life-and-death issues, they are probably juggling complicated schedules and difficult circumstances.
Warn chronic no-shows that they will be blocked from future service. Encourage them with reminders about appointments. But don’t hit them in the wallet.