Is Your State Stealthily Privatizing Medicaid and Putting Patients at Risk?
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Indeed, some of the managed-care contracts may provide substantial disincentive toward quality care. In Louisiana, health care providers will be paid a monthly flat fee for each enrolled patient, what Health Secretary Bruce Greenstein called "pre-paid coordinated care networks." Alshamsa points out this model means that publicly traded plans have little incentive to deliver quality care, saying that “these companies can only turn a profit by denying as much care as they can to those who are being forced into this system. In other words, they have a huge profit motive to mistreat and under-treat the people who rely on medical care in order to stay alive.”
It should be no surprise, therefore, that Jindal has resisted quality control moves on the part of the Legislature. This year, Senate Bill 207, which would have set a renewal period at 2014 and required detailed reports on the plan’s success, including the number of denied claims, was passed by the Legislature but vetoed by Jindal. Alshamsa asks me, “what happens if they can't do what they've promised? If you're disabled and in need of care that these companies can't actually deliver, what then? Are we supposed to just wait three years and then hope that the next companies that are awarded contracts will give us the care we need? I mean, Jindal vetoed the bill that would have added accountability measures to this scheme. That means that these companies won't ever have to prove that they are actually providing the care that patients need.”
Further complicating the picture, two firms are already disputing the fairness of the Jindal administration’s decision, calling for the heath state agency to release all of its scoring documentation and the winning proposals from three firms. Louisiana Democratic State Senator Butch Gautraux has been an outspoken critic of the Louisiana bidding process. He told me, “my complaint is the way the contract was awarded in a clandestine and secretive manner, but I think it’s too early to tell if the delivery [of Medicaid] will change.” The move toward managed care in Louisiana has been anti-democratic at every step of the way--being neither democratically voted in nor with any checks and balances on accountability.
Of course, there are some signs that the privatization of Medicaid may not all be smooth sailing at an institutional level. In Illinois, where over 40,000 Medicaid patients are being put into managed care, the move is meeting with resistance from care providers. Out of Chicago’s leading academic medical centers, only the University of Illinois at Chicago Medical Center has agreed to join the new Medicaid program, while only one of Will County's four general hospitals has come on board. In a statement to the Chicago Tribune, the Loyola University Health System confirmed that it was not joining the managed care pilot program because "our expenses for Medicaid exceed our reimbursement."
Given that academic centers tend to treat the most difficult cases, this is bad news for many of those 40,000 patients in Illinois -- but a measure of how fraught the road to privatization may be. What is good for publicly listed companies may not be good for doctors or patients.
The U.S as a nation spends a far greater amount of public money on healthcare (16 percent of its GDP) than other developed countries with universal healthcare -- over 40 percent more than the country spending the second-largest share of GDP (France 11.2%) -- and delivers a far worse system with decreased doctor visit time and increased drug and visit costs to the patient. In written testimony to the Illinois House delivered this January, Dr. Anne Scheetz noted that “that the only health care system capable of controlling costs is, paradoxically, one in which everyone has access to care, because only a universal system is able to reduce the bureaucracy that consumes at least 30 percent of our health-care dollars.”