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Bill would make doctors treat Medicare patients

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    Democratic House Speaker Joe Souki introduced the bill Friday, saying it would ensure that all people get medical treatment, regardless of their income.

Hawaii lawmakers are introducing a bill to require all doctors practicing in Hawaii to treat Medicare patients.

Democratic House Speaker Joe Souki introduced the bill Friday, saying it would ensure that all people get medical treatment, regardless of their income. Souki says that if passed, physicians who refused to take Medicare patients wouldn’t be able to reapply for their state medical license, which must be renewed every two years.

Souki says he expects push back from physicians who complain about Medicare’s low reimbursement rates.

Hawaii’s Medicare enrollment data shows a 30 percent increase from 2010 to 2012 in the number of seniors relying on Medicare for health insurance.

A 2012 study published in the journal Health Affairs shows that 69 percent of Hawaii doctors accept Medicare patients.

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      • The real problem is the high cost of living in Hawaii. Medicare reimbursements should be adjusted for the cost of living in each state. It costs much more to practice medicine in Hawaii than it does in Mississippi. Docs in Hawaii should get paid more from Medicare to cover their high costs. This is why docs are leaving Hawaii. It’s extremely difficult to maintain a practice in Hawaii on what Medicare pays doctors.

    • How is it a good thing? Would you enjoy working at a job that not only is slow to pay you for your services, but also pays only a fraction of what you should be paid?

      • Yes, but receiving medical care is an essential service. How many people have worked hard all their lives and when the savings are depleted, they can’t afford medical care. This is not right. I hope they pass the bill. Let’s take care of our senior citizens!

        • Housing is essential too. Due to the high amount of homeless, we should force landlords to rent to low income, and let the landlord take the financial hit. Roofers and contractors should provide services to low income people at a steep discount if their roof leaks or they have issues with their home. Clothing is essential- Macys should be forced to sell clothes at a discount to low income. Same with grocery stores. Those are all basic needs that private business must accept, or they will not be allowed to run a business in Hawaii.

        • Some worked hard all their lives, some hardly worked all their lives. Just leave things as is. Those docs that take medicare patients still can. Would you work knowing that you’ll not be fully reimbursed, hardly. Pressure congress to up the medicare reimbursement.

        • Maya also wants car mechanics to give him a discount with the flat rate to fix his car.

        • What about the doctors who worked hard all their lives to achieve in school, far beyond most people, and have HUGE medical school debt, yet being forced to take minimum reimbursement for services rendered, and the unknown when those reimbursements will show up in the mail??

      • Too bad. The medical industry is a regulated profession. You want to be a doctor, then you have to play by the rules. Don’t like it? Go work at Starbucks.

        • It is a regulated profession in that physicians have to comply with rules on quality- obtaining a medical license, being current on CME . It is not up to the state to dictate to PRIVATE citizens the conditions of their workplace, and the salary they must receive. This is Marxism Leninism, and the only outcome is physicians leaving Hawaii. Lets face it, who wants to stay in a state in which your salary is dictated by the state, who you treat is dictated by the state , and you pay $600,000 for a house which in the mainland US would be considered low income for the type of house that is common in Hawaii. At the same time being forced to pay for private school tuition because the public schools in Hawaii are terrible. Or, you can move to the mainland, buy a 4000 sq foot house for $300,000, live in a good school district, and not have Marxism shoved down your throat. Your call ,Hawaii. Stop this nonsense, or have great difficulty finding a doctor because they have all left for greener pastures.

        • Yeah, with that attitude, I’m sure we’ll attract the best doctors. *smacks face* (I needed to add that because some wouldn’t get the sarcasm in that). It’s pathetic that anyone thinks it’s OK to dictate what one’s salary should be. The people that support this bill disgust me.

      • I agree but Congress will not change the law to prohibit this. Our delegation isn’t protecting Hawaii. That should be the only thing on their mind!

    • just like forcing Households to use Union Labor and wages to do side jobs for their homes.
      Medicare and health providers need to increase payments to doctors and doctors and healthcare need to control their wages and costs…

      • Agreed, 1local, this State is already #1 as the worst State to do business. We have a one party system, ruled by career politicians, most of whom vote for a living telling people with a doctor’s degree how to do their business when doctors have to employ Union workers at Union wages– since this is not a Right to Work State but THEY have to take the fall on lower incomes. This is a FEDERAL matter–where is our Congressional Delegation??? Sorry, we voted in all D’s when, if we had voted R’s we could have had a say–right????

        • And if you voted in all R’s we wouldn’t have any health care except for the very rich. I think your Dr. should recommend that you stop drinking the Kool-Aid.

    • I think the concept of involuntary servitude is obviously lost on this legislature. It equates with slavery and now with the instantaneous, 24/7 news cycle has been sent by Facebook and Twitter to every medical student in the United States. This will instantly translate to everyone of them as Hawaii being the worse State to practice in with politicians making and creating crazy demands on the medical profession. Topping off the fact that Hawaii’s legislature is firmly in the grip of the trial lawyer’s control, really makes any good doctor avoid setting up a practice here. So in one fell swoop, Joe Souki will have single handedly driven away the next generation of good doctors from practicing in Hawaii. Thanks for shooting everyone in the foot with this stunt!

      • That sounds correct. This is what happens when you do NOT have term limits for State legislatures. You get people like Souki ans others in charge and stuff like a train to nowhere, a convention center with over 300 million still owed by taxpayers and this type of legislation. Don’t anyone claim the train is a city project and not State. The State legislature has just as much a hand in it as the city and all use HART to claim clean hands.

    • So easy to force others to do something that they don’t want to do, as long as it isn’t you. That’s so UnAmerican, the founders made a constitution to protect us from this tyranny. But this is not the case for the corrupt Democrat Party cronies who believes they are above the Constitution, and the people.

    • Farkward, this bill is a bad thing. The consequence of such a law will destroy Hawaii’s medical industry and cost all of us. Keep the government fingers out of the medical industry. This one no can play with, and we must be very very careful in what we do.

    • Most industrialized countries have government owned medical clinics and hospitals that treat anyone. Those that can afford to pay for their medical care can continue to see their private doctors, everyone else gets treated for free by the government. Remove the middle man (insurance companies) as there is no real need for them. Medical school grads can serve their internship in government owned facilities, Doctors can continue to work there in exchange for tuition waivers.It’s really not that complicated if Congress were to decide to act in the best interests of all the people, not just some of them.

  • So why don’t they fight for higher reimbursement rates for Hawaii given our high cost of living. our Congressional delegation has never done anything.

        • You need to learn about Medicare and its history, which has nothing, absolutely nothing, to do with Obamacare. In July 1965,under the leadership of President Lyndon Johnson, Congress created Medicare under Title XVIII of the Social Security Act to provide health insurance to people age 65 and older, regardless of income or medical history.

        • Force all airlines to transport the homeless for free. This proposed Medicare law will open up Pandora ‘ s Box. One thing will lead to another.

        • In response to BluesBreaker: I don’t recall this being a pressing issue until 2013. That is the year that CMS reduced the Practice Expense portion of Medicare reimbursements by about 50%. That and the amount of time it takes to prepare and receive Medicare reimbursement are why so many in the medical field choose not to treat Medicare patients.

        • Pure BS, maya. The practice of medicine is a humanitarian healing art, not a business. Physicians and nurses historically have stepped in to care for patients regardless of risk or expectation of reward. Any health professional who thinks otherwise should find another line of work — like selling Amway, maybe.

        • Justin- dude- Art does not pay for the rent, utilities, employee payroll, benefits, office supplies, medical supplies like autoclave etc, insurance for workmans comp, etc. In Hawaii, you have to make a lot of money daily just to meet overhead. If you have gone to school,and complete your training in your 30s, there should be an expectation that you will make a comfortable living. Especially when you are in debt after graduation, and are working in a high stress career. If you want physicians to live like starving artists, they won’t go into medicine. They will explore other careers. We are talking about very intelligent people, and they are not fools. I am a nurse, and I do expect to be paid appropriately. I have to feed my family, too.

        • Mike, what does this have to do with Republicans, being as Hawaii is a Democrat state,and an elderly House Speaker on Medicare wants physicians to serve him, slave vs master

      • I know what I would do if I was a doctor who had one of these legislators as my patient? Especially if I was specialist, orthopedic surgeon. Everybody gets old…. gets joint pain…..arthritis….. knee/hip replacement…. referral to a “hack”.

  • So they want to force physicians to take patients whose government reimbursement are too low to cover the cost of the treatment? This will force the physicians to push to raise their fees from private insurance in order to “transfer” the cost. Another way to take from the working middle class with increasing insurance premiums. Same as Obamacare’s impact on rising premiums. If government reimbursements from Medicare and QUEST were raised there wouldn’t be an issue but that means increased taxes. Either way, there is a hit to the average guy/gal. Scary part here is if you take out the whole medical aspect of this situation, the government wants to force a private business to “sell” a product or service at a fixed price lower than the cost of goods. How can any business stay open under that model?

    • “. . . patients whose government reimbursement are too low to cover the cost of the treatment” You mean patients whose government reimbursement doesn’t provide a sufficient profit margin. It’s all about maximizing profits for docs. The current trend among doctors is to charge an annual of fee of $5,000, just for them to continuing seeing you as a patient – even if you’ve been a patient for years and have always paid on time. It’s nothing more than greed, pure and simple.

      • Blues, does the “$5,000 annual fee” you assert is charged by (all) doctors show up as a line item in their billing statements?? My doctor sure doesn’t do this! If your’s does, maybe you should consider changing doctors, or are you just spouting unfounded and unsubstantiated hype and bs to fan the flames?

  • They could pass this law, but it does not pass constitutional muster. Forcing someone to accept an arbitrary compensation for work performed is by definition “involuntary servitude”. This is illegal under the Constitution. They can try this, but expect huge legal fees the state will have to pay to defend this. It wouold be tied up in courts for years. You could extend this to any profession- a lawyer may be forced to represent someone who does not have enough money to pay his fee. An electrician or plumber may be forced to provide services to someone because they are poor. The best way to deal with Medicare is to increase the pay schedule, or the very least reduce the paperwork burden. If you all think Medicare is for the elderly, under Obama he has extended it to young adults with medical problems like addiction. I work in the healthcare field, and I see increasingly more and more young people under the age of 65 on Medicare. It is a scam that you are all paying for, and it takes away the benefits that the elderly deserve.

      • Medicare was never designed for the disabled. That should have been covered under Medicaid. Medicare was designed ( until Obama) for elderly above age 65, and patients with end stage renal disease who were on dialysis for more than 6 months. Now, addicts, alcoholics, and from what I have seen- heart disease that does not prevent them from working- are all on Medicare. That is why the reimbursement is dropping, because Obama has extended Medicare to a population which should not be getting it.

        • Bluesbreaker- If your disease is so horrible that it forces you to not work, then you have low income and qualify for Medicaid. If you do work, and your disease costs would put you in a low income level, then you can also qualify for Medicaid. Medicare was for the elderly and ESRD patients. Expanding it has ruined it for the elderly, whom many paid Medicare taxes all their life. The 30-50s year old patients did not pay into the system, and are getting a free ride on the backs of the elderly.

        • maya you really need to get your facts straight. I was forced on to Medicare in 2000 at the age of 55 because of disability long before Obama took office, so stop being a Obama hater and learn the facts before you write something.

        • Waokele- I am not going to comment on your particular situation, because I dont know anything about it. However, since Obama has taken office the amount of people under 65 on Medicare has increased dramatically. Our government has loosened the standards to obtain Medicare- to the detriment of our kupuna. Why they are being put on Medicare- I have no idea- because they are not that sick to be on it in the first place. A great many people are doing the disability scam to collect SSD and perhaps get on Medicare, and our current government is allowing it to happen. Medicare should be for the elderly, people on dialysis, or severely ill. Back pain does not cut it, neither should addictions, and a number of other diseases in which people could work and not be on the disability gravy train. The pie is only so large.

        • Maya needs to know that a patient doesn’t have to be on a deathbed to qualify for Medicare. You just have to show that you are not working in a gainful manner.

        • Mike, not working in a gainful manner? What a scam. Everyone, your tax dollars are paying for this. remember when you have to get up early to work on Monday, and know that you are supporting people who are not working. Mike, are you one of those people?

    • Of course it’s constitutional. Doctors are given the right to practice their craft, like a lot of other professions. Part of that right entails accepting conditions, like not discriminating against one group. In this case, the bill is requiring that doctors not discriminate against people over 65 who pay through Medicare. Doctors are greedy and want to charge what the market will bear, but they are getting fairly compensated for their service through Medicare reimbursements. If they think those are too low, they should be at the legislature lobbying for the state share of those reimbursements to be increased and do the same in Congress for the federal share.

      • Discrimination laws have never been used for inability to pay. They have been used for race, gender, etc. Nowhere about inability to pay for a service. It is a very slippery slope for business if the government forced people to work against their will. Is a government stooge going to tell private business how many people they must see/work for in a day? Are they going to tell grocery stores that they have to reduce their prices to the poor?Therefore, unconstitutional. If a physician refused service to a gay black man, for example- then that would be discrimination. Nowhere in our laws does it require a person to perform a service for low wage. That is why this law will stall in the courts if passed, and the Hawaii taxpayer will be paying the court costs. I worked in a clinic- for a half hour appointment the physician was lucky that he got $40 from Medicare. In Hawaii, you must make thousands of dollars a day to make rent, employee costs, insurance, etc. And yes, they have been lobbying for more money.

      • Take it even further- Landlords could be forced to rent to poor people who cannot afford to pay the true cost of the rental if the government pushes this agenda. Lets just say they are successful at this- all of you are next.

        • Maya, given your attitude and opinions, you should move to a right-wing state like Texas. Then you and your fellow right-wingers can secede from our union. I would cheer your departure with chants of “goodbye and good riddance!”

        • And just what do you do for a living, Justin, that makes you think you are entitled to other people’s hard work?

      • BluesBreaker says: “Doctors are greedy and want to charge what the market will bear, but they are getting fairly compensated for their service through Medicare reimbursements.”

        You don’t see any correlation between these “greedy, well compensated” doctors and the doctor shortage here do you?

        • Ignorance is expected from all the sheep that vote for anyone with a “D” next to their name. The number one welfare state libs wants more free stuff. I didn’t know Buddy Hackett was a Hawaii politician.

      • Blues, you keep using stating, “Doctors are greedy,” but it is likely far from the truth. They spent MANY years in school, more than most people on the planet, years in internship and residence honing their skills, and paid many, many times more that other people for their college education. Doctors have earned the right to compensation to cover their efforts and expenses. And, they don’t deserve to have to provide services knowing they’ll have to take a major cut in reimbursement and an unknown delivery time of that reimbursement.

  • This bill it the equivalent of telling a business who sells a product at a certain price that he is required to sell his product to a group of consumers for a lower price (even if the business loses money) or he can no longer do business in the state. Not sure if this would fly for most people.

    • “…he is required to sell his product to a group of consumers for a lower price (even if the business loses money), and payment for the low price would be sometime in the future, not immediately,…” *fixed*

  • Medicare was supported by Republicans and Democrats. And the Medicare Reform act which redid Medicare was supported by George Bush and Republicans. When Obamacare was being discussed, many Republicns suggested that all we needed to do was to expand Medicare at the Federal Leval and Medicaid at the State level. The Republican bills supported both requiring doctors to take medicare patients and would require changes to private insurance to interface with Medicare. Too bad the Republicans and Democrats were not able to do this.

  • This bill could back fire on us. It may cause an exodus of Doctors who aren’t agreeable to accept patients under this bill. The acute shortage of Doctors would be a disaster to our isolated and middle of the ocean State!

  • Another brilliant idea from Speaker Souki. How this guy is again Speaker is hard to understand unless it is because with
    Souki anything goes as long as you got the “cheddar” and know how to spread it around.

  • Democratic House Speaker Joe Souki introduced the bill states “.. physicians who refused to take Medicare patients wouldn’t be able to reapply for their state medical license.”

    To enforce such a ‘burden’ on doctors may cause a backlash resulting in some closing their practices and leaving for the mainland.

    The fact of the matter is medicare recipients must contribute more to the system this year and in the future. They are already faced with increased costs on ‘fixed’ incomes in many cases. To be denied treatment is a travesty. However, Doctors will be forced to comply along with decreased revenues.

    Souki never talked about possible ‘tax credits’ to offset the costs of doing business to Doctors who comply.

  • Venezuela did the same thing with their grocery stores and other markets. Guess what happened there? The black market is thriving and grocery store shelves are empty. How can you stock the shelves if you are forced to sell something for less than what it costs? I guess shooting for 100% for some means that everyone will go without. Thanks alot Souki. Ayn Rand was really working the crystal ball. Perhaps the legislature should read the book or watch the movie.

  • Problem is will this bill further aggravate the doctor shortage problem in Hawaii, particularly the outer island? Other issues expressed are interesting regarding the restraint of trade and constitutionality of the bill? Not expressly mentioned is socialized medicine or better yet the emergence or forward movement to socialism? Each individual is forever dependent on the State who will dictate your future. Once classified your career is also managed by the bureaucrats. Thus, your life will be managed by the State. Additionally the State will dictate your religious beliefs. It is endless? Even what you are going to eat, sound ridiculous? Yes!

  • Appears that Souki in his old age has become more mentally incapacitated than ever. As an outer-island Representative he knows very well that the outer-islands have a difficult time attracting physicians to practice. This bill would discourage physicians from setting up shop in Hawaii and only add to the current physician shortage experienced on the outer-islands. A stupid and ill-advised bill Mr. Speaker.

  • I can respond first hand as to how this will negatively impact the physician shortage in Hawaii. I spoke with my daughter who is a resident in a medical specialty, who just read this article and she is livid. Presently she intends to return to Hawaii to practice, but this may change, as I am sure the passage of this bill will impact the decision of other doctors. She informed me that Hawaii is already ranked as one of the worst states to practice medicine and this will only compound already existing problems in the system. As an example of the shortage, my Dad needed to see a specialist and had a waiting time of three months for his first appointment. The doctors in her field are aging and many are approaching retirement age, sooner if they it is dictated how they practice medicine. She is one of many who will rethink coming to Hawaii to practice in an already unfriendly state. She is just one doctor, but one doctor networking with others can impact an already fragile system. Thank you.

  • What does Souki do for a living besides being a politician? Tell him to do his job for a substantial percent reduction in his salary and contribute the difference to charity. Hawaii is truly a socialist state.

  • I really enjoyed reading the discussion on this topic. I think this has been said in various ways already, but I’m concerned that if Hawaii forced all physicians to accept medicare patients they will lose their ability to protect against future reimbursements cuts. If payments were cut today fewer physicians may choose to accept payments and the ideally the system should correct itself (by increasing reimbursements until all patients are seen). From a quick search it looks like we already have one of the lowest per enrollee spending for medicare patients in the nation despite higher costs of living, so substandard reimbursement would be a logical place to start in correcting this issue ( (yes, 2009 numbers but I suspect we are still towards to bottom)) I think some of these worst case scenarios voiced today could be true if we take away this freedom from our physicians. I know they have a duty to medicine and their patients, but we shouldn’t put more financial strain on them by asking them to work more for less.

  • This might be a good time to invest in moving companies, which will be relocating a bunch of Hawaii’s doctors to the mainland. Prepare to line up, comrades: Hugo Chavez-style waits for medical services are coming our way. Thanks, Dems. You are every bit as bad as we say you are.

  • Does anybody here really believe Joe Souki is going to get this bill through? Lawyers, doctors,and politians all play on a golf or something similar. They all must be asking themselves ” what little tick crawled up Souki’s a.. today? “. He is always shooting his mouth off…..just more now that he is getting older and nobody listens to him.

  • oh joy. this is the start of the full blown nanny state. the state will provide all things to everyone and if they can’t, they will force you or me to provide it. i smell a lawsuit against the state.

  • This is so stupid. If the legislature can force doctors to take medicare patients in order to do business in Hawaii, the next thing they will do is force anyone who needs a license for anything to vote Democrat as a condition for receiving it. Welcome to the People’s Republic of Hawaii.

  • As a doctor, taking patients with Medicare is a nightmare. If they do pass these kinds of bills, perhaps they can give doctors some type of administrative help in dealing with the federal bureaucracy. Imagine if your employer gave you 2/3 of your regular pay, and made you do twice as much paperwork on your time card to get this amount. And if you did it wrong you would lose your license to work and face jail time. That is what pressure doctors are under when they take Medicare patients.

  • “Souki says that if passed, physicians who refused to take Medicare patients wouldn’t be able to reapply for their state medical license, which must be renewed every two years.” yup that would sure solve the problem wouldn’t it?

  • Ask a doctor who has his/her own practice for their opinion and you will find out why doctors refuse to accept Medicaid/Medicare patients. Further, ask a doctor if he/she would have their children become doctors? Why and why not? You will be shocked to hear what they will say and the threat to their profession.

  • If doctors are going to be required to accept Medicare patients, it needs to be on a national level and not a sate level. Because the federal government can help by increasing the Medicare reimbursements. If the state government is going to pursue a law like this, it will have to find a way to lower the cost for doctors (e.g. tax credits or deductions). Doctors are already leaving the state or the profession. A one-sided mandate to force doctors to accept Medicare patients would only increase the exodus.

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