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CAPITOL PERSPECTIVES column By J. McManus LIFESCIENCELEADER.COM 12 JANUARY 2015 AMNESTY HIGHLIGHTS THE INEQUITIES OF OBAMACARE cians listed as serving Medicaid enroll- ees could not offer appointments to patients. Democrats inserted a provision increasing Medicaid reimbursements to primary care physicians to the Medicare level. This policy resulted in a 73 per- cent increase in payments, on average, to primary care physicians, according to the Kaiser Family Foundation. Just one problem — the provision lasted for just two years and expired at the end of 2014. Why? It was a budget gimmick to mask the true cost of the program. Primary care physicians are now just finding out that the enhanced payment was temporary, so many may stop taking Medicaid beneficiaries. This would ren- der the coverage expansion essentially meaningless — if you cannot see a physi- cian willing to treat you, the coverage is in name only. What is the administra- tion's answer to this self-created crisis? Last year's budget suggested a one-year extension of the policy, leaving the iden- tical cliff in the following year. More gim- micks. Certainly, a Republican Congress could take up the cause and put its own imprint on a policy to address the Medicaid payment-and-access issue by delineat- ing clear metrics on whether a payment enhancement extension is solving the access problem, and perhaps targeting it at the most vulnerable populations to contain costs. But presidential leader- ship is needed on a program that bears the president's name. Fortunately, 15 states have announced plans to extend the payment enhancement on their own, but failing congressional action, that would establish even more inequities across the country. Obamacare implementation also has yielded bizarre inequities across pop- ulations in terms of covered benefits. Infertility afflicts one out of eight cou- ples and can be caused by medical condi- tions such as cancer, physical trauma, polcystic ovary syndrome, and endome- triosis. Yet infertility treatments were not included in Obamacare's "essential benefits," and the 15 states that presently mandate that benefit will have to pay its full premium cost in 2016 or repeal the mandate. JOHN MCMANUS is president and founder of The McManus Group, a consulting firm spe- cializing in strategic policy and political counsel and advocacy for healthcare clients with issues before Congress and the administration. Prior to founding his firm, McManus served Chairman Bill Thomas as the staff director of the Ways and Means Health Subcommittee, where he led the policy development, negotiations, and drafting of the Medicare Prescription Drug, Improvement and Modernization Act of 2003. Before working for Chairman Thomas, McManus worked for Eli Lilly & Company as a senior associate and for the Maryland House of Delegates as a research analyst. He earned his Master of Public Policy from Duke University and Bachelor of Arts from Washington and Lee University. Meanwhile, Medicare recently deter- mined sex-change operations to be "rea- sonable and necessary" for Medicare's seniors (average age 76) and will be cov- ered. Federal taxpayers will finance a sex-change for an individual who has lived 80 years as Jane to become Joe, but cannot assist a young couple who can- not conceive because the hopeful mother cannot get pregnant due to chemothera- py or radiation for her cancer. In whose reality does this inequity make sense? A first step to addressing the emerging inequities in Obamacare is for President Obama himself to recognize and own the current implementation challenges of the law. This means suggesting solutions for the poorest individuals who cannot obtain coverage or see a doctor even if they obtain Medicaid coverage. It also means productively engaging in a real dialogue with Republicans, who will, for the first time in his presidency, control both houses of Congress. Issuing further executive orders and taunting his opposi- tion is no longer a sustainable strategy. l 23 States (shown in blue) Have Not Expanded Medicaid Sources: The Advisory Board Company (map) and Families USA (numbers of uninsured) In these states, 7 million Medicaid-eligible people remain uninsured