INTEREST OF AMICI CURIAE
Amici are among the largest and most prominent medical and dental professional associations in the United States. Collectively, the members of these professional associations provide medical and dental services to literally millions of patients covered by the Medicaid program. Amici are uniformly committed to promoting the betterment of public health and improved access to health and dental care for Medicaid recipients. They are profoundly interested in this case because its outcome will affect the ability of all Medicaid recipients to assure that they have access to medically necessary services as mandated by the Medicaid Act. States? failure to comply with the Medicaid Act?s ?equal access? provision has a well documented and negative impact on patient care, often creating unnecessary risks and poor health outcomes. Restricting the availability of a remedy through the courts would leave the Congressional mandate of ?equal access? an empty promise.
The American Medical Association (?AMA?) is the largest professional association of physicians, residents and medical students in the United States. Additionally, through state and specialty medical societies and other physician groups, seated in the AMA?s House of Delegates, substantially all physicians, residents and medical students in the United States are represented in the AMA?s policy making process. The objectives of the AMA are to promote the science and art of medicine and the betterment of public health.
American Dental Association (?ADA?) is the world?s largest professional association of dentists. The ADA is committed to the public?s oral health, and to the ethics, science and professional advancement of dentistry. On behalf of its more than 155,000 members, the ADA occupies a prominent role in leading the profession through initiatives in advocacy, education, research and the development of standards that are essential for the safe, appropriate and effective delivery of oral healthcare. The Association is vitally concerned with access to care issues and serves as a principal advocate on issues affecting oral health.
The American Academy of Pediatrics (?AAP?) is an Illinois not-for-profit corporation representing 60,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists. Founded in 1930, AAP has been a powerful voice for children?s health through education, research, advocacy, and the provision of expert advice. Its mission is to attain optimal physical, mental, and social health and well-being for all infants, children, adolescents, and young adults. AAP is the largest professional association of pediatricians in the world.
The American Congress of Obstetricians and Gynecologists (?ACOG?) is an Illinois not-for-profit corporation representing more than 50,000 obstetricians and gynecologists and residents in obstetrics and gynecology. ACOG is dedicated to the advancement of women?s healthcare and to establishing and maintaining the highest possible standards of practice. ACOG also promotes policy positions on issues affecting the specialty of obstetrics and gynecology and supports quality health care for every woman throughout her life.
The American Academy of Family Physicians (?AAFP?), headquartered in Leawood, Kansas, is the national association of family doctors. Founded in 1947 as a not-for-profit corporation, its members are physicians and medical students from all 50 states, the District of Columbia, Puerto Rico, the Virgin Islands, Guam, and the Uniformed Services of the United States. As part of its mission, the AAFP seeks to improve the health of patients, families, and communities by serving the needs of members and their patients with professionalism and dignity and by advocating for public health.
The American College of Emergency Physicians (?ACEP?) is a nonprofit, voluntary professional and educational society of over 29,000 emergency physicians practicing in the United States and other countries. Founded in 1968, ACEP is the nation?s oldest and largest association of emergency physicians. ACEP fosters the highest quality of emergency medical care through the education of emergency physicians, other health care professionals, and the public; the promotion of research; the development and promotion of public health and safety initiatives; and the provision of leadership in the development of health care policy.
Many of Amici?s members care for Medicaid patients. Low Medicaid reimbursement rates impose an unfair burden on those members who accept these patients, and additional members of Amici would care for Medicaid patients if the reimbursement rates were not prohibitively low.
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SUMMARY OF ARGUMENT
The ?equal access? provision of the Medicaid Act, 42 U.S.C. § 1396a(a)(30)(A), mandates that states accepting federal Medicaid funds set provider reimbursement rates using ?such methods and procedures? as necessary to assure, among other things, that payments are ?sufficient to enlist enough providers so that care and services are available under the plan at least to the extent that such care and services are available to the general population in the geographic area.? As a practical reality, however, the promise of ?equal access? has been largely illusory for many of America?s most vulnerable citizens. Federal courts, scientific researchers and governmental bodies have consistently found a chasm between Medicaid and private insurance in the availability of needed health care services. Twenty years after the statutory enactment of the equal access mandate, discrepancies in access to care pervade. Members of the Amici see these discrepancies every day in their own practices. Whether it be a futile attempt to find a Medicaid-participating pediatric neurologist or dentist for a young patient or treating a Medicaid beneficiary in the emergency room who cannot find a primary care physician, there are constant reminders of the access crisis in our public health system.
There is a well-established and predictable correlation between Medicaid provider payments and physicians? willingness to treat Medicaid recipients. Indeed, the equal access provision was itself enacted with the common sense recognition that ?without adequate payment levels, it is simply unrealistic to expect physicians to participate in the [Medicaid] program.? H.R. Rep. No. 101-247, at 390 (1989). The United States Government Accountability Office (?GAO?) recently reported that for physicians who choose not to participate in Medicaid and the Children?s Health Insurance Program (?CHIP?), 95% are influenced by low provider reimbursement rates. See?Medicaid and CHIP: Most Physicians Serve Covered Children but Have Difficulty Referring Them for Specialty Care,? GAO-11-624, at 18 (hereinafter referred to as ?2011 GAO Report?).
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