DPC and Medicaid expansion politics.

DPC docs uniformly recommend that their non-indigent patients have wrap-around insurance coverage. But for indigents, particularly for what are known as “Medicaid expansion adults” too many DPC docs are willing to push their state for an indigents’ program heavy on direct primary care coupled to, at best, skimpy coverage of downstream costs. They’re eager for their states to send a windfall their way, and apparently quite willing to provide ammunition for fiscal conservatives whose only real goal is spending as little as possible on indigent care.

Peer-reviewed research has confirmed that full Medicaid expansion has significant health benefits for its beneficiaries. For DPC providers to fuel the opposition to full Medicaid expansion by supporting “DPC+ (too little)” is not a good look.

DPC providers would do well to look at this through the eyes of an indigent beneficiary given a choice between full Medicaid expansion (even if, heaven forfend, it comes with FFS primary care) and whatever flavor of “DPC+chintz” they are asked to get behind.

At least DPC advocates should think their own interests through quite thoroughly. Those militant cost-cutters always find a way to cut indigent care; they are the folks who have always made sure that Medicaid reimbursement rates be meager. If DPC actually was so effective that a “DPC + chintz” plan resulted in the indigents getting anything resembling comparable care to the non-indigent, after a year or two fiscal conservatives will complain that “the poor don’t deserve care as good as everyone else’s”, and cut to a meager level the amount they pay DPC providers .

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