By Donald H. Marks, MD PhD, FACP
Physician, scientist and 3rd generation veteran
13 July 2026
In the USA, having health insurance is not synonymous with having access to care. A primary barrier is that many physicians and medical systems refuse Medicare and Medicaid patients. In 2018, while 90% of physicians accepted new Medicare patients, only 72% accepted Medicaid. Cited reasons include low reimbursement rates and high administrative burdens. As medical professionals, we should address this gap by advocating that medical licensure be tied to the acceptance of all insured patients, including those on government programs.
Medicare and Medicaid are two government programs that provide health coverage to millions of Americans. Medicare covers 67 million citizens ages 65 and over, as well as 8 million younger adults with certain chronic conditions or disabilities. Medicaid is a joint federal-state program that provides health insurance to low-income individuals and families. To date, 41 states (including DC) have adopted the Medicaid expansion, and as of June 2023, approximately 94 million persons are covered by Medicaid and Children’s Health Insurance Program CHIP.
The Social Contract and Public Funding
Virtually all U.S. physicians MD DO NP receive public funding during their training via medical school subsidies, residency programs, or military sponsorship (in my case). This investment creates a social obligation to serve the public. Advocates argue that accepting Medicare and Medicaid is a way to repay this debt, ensuring equitable access and reducing the burden on the uninsured healthcare system.
Systemic Challenges and Counterarguments
Physicians face real obstacles: lower reimbursement rates and more complex medical needs among Medicaid populations. Opponents of mandated participation argue it violates professional autonomy and could exacerbate provider shortages if doctors retire early or relocate. However, the alternative—denying care to the sick—is far more onerous. Rather than purely punitive measures, we must pair licensure requirements with incentives like realistic reimbursement rates and reduced administrative barriers.
Health Equity and Ethics
Health equity demands that everyone has a fair opportunity to attain their highest level of health. Doctors who opt out of government programs such as Medicare and Medicaid intentionally contribute to health disparities. By prioritizing financial interest over patient need, they ignore the social determinants of health—such as poverty and environment—that influence patient outcomes. True reform requires a transition to universal coverage and addressing the "essentially uninsured" who face unaffordable premiums and deductibles.
The intersection of medical licensing and insurance participation is complex, but the goal is clear: upholding ethical standards while ensuring access. By addressing the root causes of provider opt-outs—specifically reimbursement and red tape—and tying medical licensure to community responsibility, we can move closer to a just healthcare system for all.
References
Physicians who refuse to accept Medicaid patients breach their contract with society https://www.statnews.com/2017/12/28/medicaid-physicians-social-contract/
What is Health Equity? | Health Equity | CDC
https://www.cdc.gov/nchhstp/healthequity/index.html
https://www.cdc.gov/healthequity/whatis/index.html
Health Equity. WHO. https://www.who.int/health-topics/health-equity
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