ATLANTA --- Sandra Reed became an obstetrician because she wanted to deliver babies.
Now her Thomasville, Ga., office has added laser treatments and hair removal services -- cash-making ventures -- to help pay the bills.
Reed, who relies heavily on Medicaid patients, has had to scramble to make ends meet because the state hasn't increased her payments for serving those on the government health insurance program for the poor and disabled. Those payments have stalled for a decade even though costs have risen.
Now, those rates have been cut as the state strains to balance its books.
Gov. Nathan Deal had proposed a 1 percent cut to health care providers, excluding hospitals hit with a separate bed tax. Lawmakers softened that to a 0.5 percent cut. The cut, which took effect Friday, is expected to save the state about $13.8 million this year.
However, it could spur some doctors to stop seeing Medicaid patients altogether, even as the Obama administration ramps up plans to expand the Medicaid rolls as part of the national heath overhaul in 2014.
Gary Richter, an Atlanta gastroenterologist, said the provider cut combined with other demands -- such as having a translator on hand for the growing number of non-English speaking patients -- have him seriously weighing for the first time whether to continue accepting Medicaid patients.
Such moves would likely create a ripple effect as Medicaid patients are forced to seek care in emergency rooms, one of the costliest options.
Matt Gove, the spokesman for Grady Health Center in Atlanta, which sees a high number of indigent patients, said Grady's emergency room volume has increased by more than 10 percent so far this year.
Doctors can choose whether to accept Medicaid patients, but hospitals must treat anyone who walks in the door.
Medicaid is funded by a combination of state and federal money. As part of the stimulus package from Washington, federal officials increased their share from 66 percent to 75 percent to help states cope during the economic downturn. That enhanced match translated into $748.9 million in Georgia for fiscal year 2010 and $608.6 million last year. This year, that goes to zero as the extra cash from Washington dries up.
Meanwhile, Medicaid enrollment keeps climbing, driven by high unemployment and the sluggish economy. Georgia had 1.35 million residents on Medicaid in fiscal year 2008, compared with 1.5 million in the fiscal year that ended June 30. That's more than 15 percent of the state population.
The problem is compounded by a shortage of doctors. The Association of American Medical Colleges estimates that 15 years from now, with the ranks of insured patients expanding, the United States will face a shortage of up to 150,000 doctors.
A 2006 report from the Georgia Board for Physician Workforce found the state ranked 37th in the nation on physicians per capita.