Dr. Edison Manaloto isn’t simply a physician and Guam Regional Medical City’s Chief Medical Officer. He’s also a certified public accountant, a certified government financial manager, and a certified healthcare finance professional, making his expertise and opinion unique in the cross section of medicine, healthcare, finance, and government in Guam. So, when Dr. Manaloto talks about public policy that will affect people’s access to medical and health care and analyze these proposals inclusive of their cost and investment profile, he offers credibility that not many others – if any on island – can provide.
Today in an interview with Kandit, Dr. Manaloto talked about his support of Sabrina Salas Matanane’s legislation that would gives business privilege tax breaks on Medicaid revenue earned by doctors and clinics that provide services to Medicaid patients.
Nearly 50,000 of Guam’s roughly 150,000 residents – a third of the population – depends on Medicaid to pay for health and medical costs that arise. The problem, according to Dr. Manaloto, other doctors, government professionals, senators, and Medicaid subscribers, is that 1) there are not enough doctors in Guam, and 2) of the doctors practicing, not enough of them accept Medicaid patients. Public officials have long argued that GovGuam’s slow reimbursement process has made it financially unviable for doctors and clinics to accept Medicaid patients.
These factors, coupled with what Dr. Manaloto calls “social determinants of health” have sent Guam’s healthcare problems through a vortex that is ending up costing the people of Guam much more money than the community should be paying and worse, costing lives and livelihoods. Medicaid is a federally funded health insurance program generally for lower income residents, or residents who meet other specific social or health thresholds. These are people who are more likely to live with circumstances that will tend to make them less healthy than the rest of the population. For example, people without reliable transportation are more likely to miss doctor appointments or to otherwise receive the medical care they need. Or, as another example, Medicaid subscribers are more likely to rely on the Supplemental Nutrition Assistance Program, commonly known as SNAP or food stamps. Their budget to eat for the month makes it more likely they will consume foods that are cheaper, and generally less healthy.
Ms. Salas Matanane’s Bill No. 118-38, co-sponsored by a bipartisan supermajority of senators, would shave off 1 percentage point of the BPT on Medicaid revenues providers earn, with graduated reductions in the BPT all the way down to full BPT relief. The bill also provides major penalties and even a lock out period for any providers or clinics that cheat the system.
This incentive and the corresponding accountability measures built into the bill, Dr. Manaloto said, will not only provide doctors with incentives to accept Medicaid patients, it also provides incentive to expand clinic locations and to recruit more doctors.
After crunching the numbers from available public data sets, Dr. Manaloto said the estimated maximum impact to government tax revenue will be around $5.9 million, which breaks down to about $118 per Medicaid recipient. The government’s investment of $118 per Medicaid recipient to be able to receive greater access to preventative and non-emergency care should, according to Dr. Manaloto, reduce those patients’ getting sicker and then presenting themselves at the emergency room or another clinical setting that will become far more expensive.
This is what he says the medical community terms as a readmission rate. And according to a 2018 study, the average adult readmission cost was $15,200, with Medicaid patients generally costing more.
The tax policy Ms. Salas Matanane is proposing – and for which the governor issued support in her report of the state of the island this year – isn’t just about access to care, but is a smart financial investment the government should make.
Watch our full interview with Dr. Manaloto here:
