Two rural state senators representing some of the state’s poorest areas stood staunchly this spring against expanding the state’s Medicaid program to insure an estimated 400,000 additional low-income Virginians.
Republicans Bill Carrico of Grayson County and Bill Stanley of Franklin County delivered floor speeches predicting that the expansion, like many social programs, will cost taxpayers a lot more than expected. They said the enlargement wouldn’t help their constituents because doctors are scarce in their regions and reluctant to accept more Medicaid patients.
“…The district I live in, 50 percent of the doctors won’t even take Medicaid patients, Carrico said on May 22. He represents the 40th Senate district in Southwest Virginia, a region pummeled by the declines of the coal and manufacturing industries.
Stanley represents the 20th Senate district in Southside Virginia, a region pounded by the collapse of tobacco farming and manufacturing. In a May 29 speech explaining why state senators from Southside and Southwest oppose expanding Medicaid, he said, “we know that less than 50 percent of our doctors even take it.”
Similar arguments were made by other opponents of expansion. We wondered whether Carrico’s and Stanley’s 50 percent figures were correct.
We left three messages at Carrico’s district office. No one got back to us.
Stanley said he got his information from a “white paper,” but couldn’t recall when he saw it or who wrote it. He said he’d get back to us but didn’t. We left three unanswered messages on his cell phone.
And then, we continued our investigation.
There is no official or steady source of data on the percentage of physicians in the U.S. or Virginia that accept Medicaid. Three widely-cited national surveys conducted this decade found a range between 70 percent and 81 percent of doctors accepting new Medicaid patients.
The largest and most recent survey – conducted in 2016 by Merritt Hawkins, a national physician recruiting firm – polled 17,236 doctors across the nation. Seventy-three percent said they planned to accept all Medicaid patients seeking their services. The report did not break down the responses by states or localities.
Scantier data is available on Virginia physicians’ participation in Medicaid. The state doesn’t keep such statistics.
A 2015 study by the National Center for Health Statistics - based on 2013 polling - found that 79 percent of Virginia office-based physicians were treating Medicaid recipients and 70 percent of office-based doctors were accepting new Medicaid patients.
A 2011 survey published in Health Affairs, a national health policy journal, found that 76 percent of Virginia home-based physicians were accepting new Medicaid patients.
It should be noted both studies were national in scope. The Virginia percentages were small subsets of national surveys and had high margins of error.
Fact-checking Carrico’s and Stanley’s statements requires us to break down the already blurry statewide statistics to even a deeper level.
We spoke to Christina Nuckols, media relations director for Virginia’s Department of Medical Assistance Services, which runs the statement’s Medicaid program. She said her department doesn’t have records on the percentage of doctors accepting Medicaid patients.
We also talked to Diane Powers, communications director for the Virginia Department of Health Professions, which licenses state physicians. She, too, said her department doesn’t compile statistics on physician participation, but directed us to some interesting raw data.
The department asks licensed Virginia physicians to report a variety of information, including whether they accept Medicaid patients. The individual responses of more than 30,000 doctors are posted online and can be accessed by locality.
The records do not produce perfect geographic results because many physicians practice in multiple localities and are listed in many cities and counties. Even so, ill, the information undercuts Carrico and Stanley.
Carrico, you’ll remember, said 50 percent of the doctors in his senate district don’t accept Medicaid. But the website doesn’t sort physicians by political districts – a task that would require a breakdown of medical offices by streets.
We came up with a broad estimate by hand counting the responses of each doctor in each locality in Carrico’s district who had filed a report since 2015, or a total of 604. Seventy-seven percent of them said they plan to continue accepting new Medicaid patients, way higher than Carrico’s claim and slightly higher than the statewide percentages estimated in studies earlier this decade.
Stanley, you’ll recall, said “less than 50 percent of our doctors” in Southside and Southwest Virginia take Medicaid.
We identified Southwest and Southside localities according to a regional map by the Weldon Cooper Center for Public Service at the University of Virginia, and hand counted 1,162 responses since 2015. Seventy-nine percent said they will continue seeing new Medicaid patients, way higher than Stanley’s claim and slightly higher than estimates in previous statewide studies.
Carrico and Stanley have provided no proof for their claims that only 50 percent of doctors in either Carrico’s district or Southside and Southwest Virginia accept Medicaid.
Until they do, we’ll regard their statement skeptically. Evidence, though far from perfect, points to a significantly higher percentage.