First, the good news. For the first time in many years, the governor has recommended additional funds for the state Medicaid budget to partially pay doctors, dentists and hospitals what it costs them to treat Georgia's Medicaid patients.

Why should you care?

When the state pays providers far less than what it actually costs to treat a Medicaid patient, everyone makes up the difference through higher health care insurance and out-of-pocket costs. That's tantamount to a hidden tax on most Georgians.

Medicaid funds more than 60 percent of all births in Georgia, and for many years, the state's Medicaid budget has been seriously under-funded.

As health care treatment costs continue to rise, Medicaid rate reimbursements for doctors and hospitals have not increased in more than eight years. Today many doctors pay out of their own pockets to cover the costs of treating Medicaid patients.

Ten years ago, our practice —- like a number of others —- made the conscious decision to see Medicaid patients because it was the "right thing" to do, for the good of the community and to fulfill the oath that we took when we became doctors. At the time, we were breaking even with each Medicaid patient.

Now treatment costs have far outpaced reimbursement rates.

At the end of the day, after a doctor has seen all his or her patients, performed all the surgeries and delivered all the babies, we still have to pay the rent, pay our employees and pay the electric bill. As much as we would like to just practice medicine, we are also a small business. Like other small businesses, doctors cannot afford to provide services for less than what it costs them.

Our options are not good. If the trends continue, we are faced with an impossible choice: stop seeing Medicaid patients (as have a number of doctors) or close our doors and our practices in a state that inadequately reimburses doctors for the cost of treatment. Many specialists, including obstetricians, gynecologists, orthopedic physicians and pediatricians are closing or limiting their practices because of low payments, resulting in additional pressure on overloaded hospital emergency rooms.

Many parts of Georgia already experience a shortage of medical specialists for this very reason. The situation will only get worse if Georgia fails to increase its Medicaid rates to cover doctors' costs. With Georgia's low reimbursement rates, the state is leaving money on the table, money that goes to other states. In total Medicaid spending per enrollee, Georgia ranks 39th in the country, bringing in fewer federal Medicaid dollars than most states.

For every dollar the state contributes to Medicaid, the federal government contributes $2. Increased state contributions mean increased federal contributions. If the governor's proposal fails in the 2008 Georgia General Assembly, Georgia will leave more than $70 million in federal Medicaid funds on the table.

In the few days remaining in the 2008 Georgia General Assembly, I encourage Gwinnett County residents to tell their state legislators that they support Gov. Sonny Perdue's Medicaid budget recommendation. It is a significant step toward our ultimate goal of full cost reimbursement.

> Dr. Edward E. Evans practices at Preferred Women's Healthcare in Lawrenceville. He has practiced in Gwinnett County for 13 years. Evans specializes in the diagnosis and treatment of female urinary/incontinence problems, high-risk obstetrics and infertility.