A bill introduced May 11 by House Republicans that would introduce Medicaid work requirements nationwide, stricter eligibility requirements and impose up to $715 billion in cuts over 10 years has faced criticism among hospital groups.
Spine surgeons discuss what the bill means for their specialty and access to patient care.
Note: Responses were lightly edited for clarity.
Philip Louie, MD. Virginia Mason Franciscan Health (Seattle): I fear that the latest Medicaid cuts that have been proposed will impact spine care access and delivery — negatively! With over $700 billion in potential reductions over the next decade, these cuts could lead to millions losing health coverage, particularly among low-income adults and those reliant on Medicaid for complex surgical care — in the setting of an already challenging environment of declining reimbursements and financial strain on healthcare systems. Private practices (which have been under immense pressure) may be forced to reconsider the patient populations they can serve, potentially marginalizing those who need care the most.
By the way, I do think that this situation also highlights more of a systemic issue: a healthcare model that rewards volume over outcomes, and penalizes complexity. We spine surgeons are more often finding ourselves at a crossroad, working to provide high-quality care within a system that doesn’t adequately value it (or hasn’t figured out how to meaningfully). The real metrics — pain relieved, function restored, lives improved — are difficult to quantify and often overlooked in reimbursement models. I don’t think that this is a reflection of our own personal failures, but a consequence of a system misaligned with the true goals of healthcare — especially as we face another round of reimbursement cuts.
Lali Sekhon, MD, PhD. Spine Surgeon at Reno (Nev.) Orthopedic Center: The 160 page bill proposed to cut Medicaid payments wants to do a few good things but the real question will be if this bill reduces access for a section of the community and reduces reimbursement to physicians further for a subset of patients that can be challenging to look after. Ensuring that addresses are verified and there is no duplication is a good thing. Assessing for eligibility more frequently is probably also ok. Asking ‘able-bodied’ adults to work 80 hours per month or participate in community engagement activities to maintain status is interesting and really depends on what is defined as ‘able bodied’ and whether these individuals can actually find work or activities. Like most things, the devil will be in the details. The real questions will be are those truly in need going to be denied care and is reimbursement for their care going to be reduced. If that happens, access will suffer and hospital emergency rooms will be overburdened.
Vladimir Sinkov, MD. Founder and CEO of Sinkov Spine Center (Las Vegas): The proposed Medicaid cuts, if enacted, will likely decrease the number of people who have Medicaid coverage for their health insurance.
I do not think it will have a very significant impact on spine care in the country overall, but the providers that see more patients with Medicaid coverage will likely see more impact and may have to adjust their practice accordingly.
On the other hand, these cuts will likely allow the Medicaid program as a whole to remain financially viable longer. Some of the people who would lose their health insurance coverage under this proposal will likely find other ways to obtain health insurance and the system will re-balance itself.
Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): In the last five years, Medicare reimbursements for hospitals and physicians have endured two-plus percent decrease across the board, definitively affecting larger health systems and centers who care for the underinsured. The proposed Medicaid legislation for 2025 appears to have some necessary verification and work requirements in its latest language, with provisional penalties levied toward states that provide funding for non-citizens and non-qualifiers. The attention to this aspect of care is long overdue. Most likely, the cost-shifting or further erosion of care to these populations will suffer, as subspecialty care within healthcare centers of excellence will be further overburdened. This additional reimbursement restriction will affect initiation and ultimately, continuity of care.
