Aa
Iowa’s Medicaid program makes the rollout of HealthCare.gov look orderly
Gotta love em' - people who think 'The Private Sector' can always do things more efficiently and cheaply than gov't. And that there won't be kickbacks and payoffs all along the way.
https://www.washingtonpost.com/opinions/iowas-radical-privatization-of-medicaid-is-already-failing/2015/12/11/58b21362-a01b-11e5-bce4-708fe33e3288_story.html?
"On Jan. 1, 31 days before Iowa caucus-goers cast the first votes of the 2016 presidential race, the state will gain another national distinction, but of a dubious variety: It plans to launch the most sweeping and radical privatization of Medicaid ever attempted.
In an extraordinary social policy experiment, Iowa’s Gov. Terry Branstad (R) is kicking about 560,000 of the state’s poorest residents out of the traditional Medicaid health-care program for the poor and forcing virtually all of them to sign up with private insurers. The trend toward managed care for Medicaid has been underway for decades and some 39 states do it to some extent. But experts inside and outside government say no state has tried to make such a wholesale change so quickly — in Iowa’s case, launching the program fewer than 90 days after signing contracts with private health-care companies.
Iowa is conducting an extreme test of a familiar premise of free-market conservatism: that the private sector is more efficient at management and service delivery than government. But the results so far should give pause to those who automatically make such assumptions. The transition of Iowa’s $4.2 billion Medicaid program has made the rollout of HealthCare.gov look orderly.
An Iowa administrative law judge late last month recommended that Iowa throw out the contract it awarded to WellCare, one of the four companies hired to manage the new program, noting that the company failed to disclose details of its “integrity agreement” with the federal government after the 2014 convictions of three former executives involving the misuse of Medicaid money. In addition, WellCare had paid $138 million to resolve claims that it overbilled Medicare and Medicaid, and the firm had also hired two former Iowa legislators, who improperly communicated with the Branstad administration during the bidding process.
The Des Moines Register has reported that the four companies selected to operate the Iowa program have had more than 1,500 regulatory sanctions combined and have paid $10.2 million in fines over the past five years. These involved canceled appointments, privacy breaches, untimely processing and failure to obtain informed consent.
The Iowa rollout has been hampered by delays, and some beneficiaries of the program are only now getting their enrollment packets, though the deadline for signing up is Dec. 17. Health-care providers complain that they are being forced to sign incomplete contracts or face a penalty, and they complain that some contracts don’t cover services that had been covered under the existing Medicaid program.
Branstad’s administration has answered critics by saying the new program will save $51 million in its first six months. But he has been unable to come up with documentation to justify the cost savings for Iowa, which already has a low-cost Medicaid system.
Branstad had the authority to implement the new program without input from the state legislature. But officials with the Centers for Medicare and Medicaid Services (CMS) were in Iowa this week and will make a ruling next week on whether the plan can proceed.
“The rollout has been an absolute unmitigated disaster,” said Democratic Sen. Joe Bolkcom, the Iowa chamber’s majority whip. “CMS and the Obama administration need to protect vulnerable Iowans from this train wreck.”
Branstad has implicitly acknowledged some difficulty. This week he extended until April the “safe harbor” in which Medicaid providers will receive 100 percent reimbursement regardless of managed-care network.
In response to my inquiry, Branstad’s office sent me to the state’s Department of Human Services, where a spokeswoman, Amy Lorentzen McCoy, said all is well. The state, which now has 12 percent of Medicaid recipients in managed care, would have gone this way anyway, she said, but the urgency increased with the recent Medicaid expansion. (Branstad was one of the few Republican governors to accept the Obamacare expansion of the program.)
Now, as the nation’s attention turns to the Iowa caucuses, Iowans will likely be witnessing either a fight between Branstad and President Obama (if the federal government forces a delay in the Iowa program) or chaos (if the program is allowed to proceed). Other states, such as Kansas and Kentucky, have tried similar experiments, but they either moved more deliberately or didn’t extend the private program to vulnerable populations such as the disabled.
“A lot of issues have been raised with the pace of the rollout” in Iowa, said Julia Paradise, a Medicaid expert with the Kaiser Family Foundation. “The provider networks for the plans have not yet been established. There’s a lot of confusion among beneficiaries.”
Branstad could recognize this, and slow things down. In failing to do so, he’s relying more on dogma — faith that the private sector always does things better — than reality."
https://www.washingtonpost.com/opinions/iowas-radical-privatization-of-medicaid-is-already-failing/2015/12/11/58b21362-a01b-11e5-bce4-708fe33e3288_story.html?
"On Jan. 1, 31 days before Iowa caucus-goers cast the first votes of the 2016 presidential race, the state will gain another national distinction, but of a dubious variety: It plans to launch the most sweeping and radical privatization of Medicaid ever attempted.
In an extraordinary social policy experiment, Iowa’s Gov. Terry Branstad (R) is kicking about 560,000 of the state’s poorest residents out of the traditional Medicaid health-care program for the poor and forcing virtually all of them to sign up with private insurers. The trend toward managed care for Medicaid has been underway for decades and some 39 states do it to some extent. But experts inside and outside government say no state has tried to make such a wholesale change so quickly — in Iowa’s case, launching the program fewer than 90 days after signing contracts with private health-care companies.
Iowa is conducting an extreme test of a familiar premise of free-market conservatism: that the private sector is more efficient at management and service delivery than government. But the results so far should give pause to those who automatically make such assumptions. The transition of Iowa’s $4.2 billion Medicaid program has made the rollout of HealthCare.gov look orderly.
An Iowa administrative law judge late last month recommended that Iowa throw out the contract it awarded to WellCare, one of the four companies hired to manage the new program, noting that the company failed to disclose details of its “integrity agreement” with the federal government after the 2014 convictions of three former executives involving the misuse of Medicaid money. In addition, WellCare had paid $138 million to resolve claims that it overbilled Medicare and Medicaid, and the firm had also hired two former Iowa legislators, who improperly communicated with the Branstad administration during the bidding process.
The Des Moines Register has reported that the four companies selected to operate the Iowa program have had more than 1,500 regulatory sanctions combined and have paid $10.2 million in fines over the past five years. These involved canceled appointments, privacy breaches, untimely processing and failure to obtain informed consent.
The Iowa rollout has been hampered by delays, and some beneficiaries of the program are only now getting their enrollment packets, though the deadline for signing up is Dec. 17. Health-care providers complain that they are being forced to sign incomplete contracts or face a penalty, and they complain that some contracts don’t cover services that had been covered under the existing Medicaid program.
Branstad’s administration has answered critics by saying the new program will save $51 million in its first six months. But he has been unable to come up with documentation to justify the cost savings for Iowa, which already has a low-cost Medicaid system.
Branstad had the authority to implement the new program without input from the state legislature. But officials with the Centers for Medicare and Medicaid Services (CMS) were in Iowa this week and will make a ruling next week on whether the plan can proceed.
“The rollout has been an absolute unmitigated disaster,” said Democratic Sen. Joe Bolkcom, the Iowa chamber’s majority whip. “CMS and the Obama administration need to protect vulnerable Iowans from this train wreck.”
Branstad has implicitly acknowledged some difficulty. This week he extended until April the “safe harbor” in which Medicaid providers will receive 100 percent reimbursement regardless of managed-care network.
In response to my inquiry, Branstad’s office sent me to the state’s Department of Human Services, where a spokeswoman, Amy Lorentzen McCoy, said all is well. The state, which now has 12 percent of Medicaid recipients in managed care, would have gone this way anyway, she said, but the urgency increased with the recent Medicaid expansion. (Branstad was one of the few Republican governors to accept the Obamacare expansion of the program.)
Now, as the nation’s attention turns to the Iowa caucuses, Iowans will likely be witnessing either a fight between Branstad and President Obama (if the federal government forces a delay in the Iowa program) or chaos (if the program is allowed to proceed). Other states, such as Kansas and Kentucky, have tried similar experiments, but they either moved more deliberately or didn’t extend the private program to vulnerable populations such as the disabled.
“A lot of issues have been raised with the pace of the rollout” in Iowa, said Julia Paradise, a Medicaid expert with the Kaiser Family Foundation. “The provider networks for the plans have not yet been established. There’s a lot of confusion among beneficiaries.”
Branstad could recognize this, and slow things down. In failing to do so, he’s relying more on dogma — faith that the private sector always does things better — than reality."
Anybody take a look at who is some of the democrats biggest donors? Oh, never mind... nothing to buy here... I mean "see here".
I said all along that when the healthcare issue first came up, it was supposed to be about everyone getting affordable "care", then the focus changed from getting care to getting insurance and when that happened all bets were off... It's not about care and it's not about people being entitled to affordable care or even affordable insurance, because they have neither of those... it's about money and whose going to make the most!! That focus needs to change...
" I'm sure there's something that will work, but is still affordable and that would "not" have to be crammed down the throats of most Americans..."
Good luck on that one, Barb. I don't know what the answer is, but I do believe we aren't looking at the heart of the problem. We've (Obama) made having insurance the issue instead of it being affordable.
We need to look at the cost of the stuff and see why it's so expensive. Pharma plays a part. Special tools, procedures, technology plays a part. Fraud plays a part.
Good luck on that one, Barb. I don't know what the answer is, but I do believe we aren't looking at the heart of the problem. We've (Obama) made having insurance the issue instead of it being affordable.
We need to look at the cost of the stuff and see why it's so expensive. Pharma plays a part. Special tools, procedures, technology plays a part. Fraud plays a part.
As a former Iowa resident who enjoyed having Terry Branstad as governor, years ago, I'm somewhat disappointed to see him make a move of this nature, so quickly; however, we see by the number of states, such as VT where doctors are leaving the state or others, such as OR where insurance companies are going out of business, that the government isn't doing such a great job, either.
I'm not sure what the answer is - perhaps they need to slow down and take a better look at the options. I'm sure there's something that will work, but is still affordable and that would "not" have to be crammed down the throats of most Americans...
I'm not sure what the answer is - perhaps they need to slow down and take a better look at the options. I'm sure there's something that will work, but is still affordable and that would "not" have to be crammed down the throats of most Americans...
article link
http://vtdigger.org/2015/12/12/four-pediatricians-leave-franklin-county-blame-medicaid/
Also interesting is how many in VT are on friggin medicaid and to see how the Democrat super majority and Progressive ideology has destroyed this once republican state
http://vtdigger.org/2015/12/12/four-pediatricians-leave-franklin-county-blame-medicaid/
Also interesting is how many in VT are on friggin medicaid and to see how the Democrat super majority and Progressive ideology has destroyed this once republican state
Results of the great government medicaid shift begin to rear their head.
(Note: VT already pays a higher reimbursement medicaid rate than many states do)
FOUR PEDIATRICIANS LEAVE FRANKLIN COUNTY, BLAME MEDICAID
Four pediatricians say they’re packing up and leaving Franklin County because the Medicaid programs that insure about half of the community’s children aren’t paying them enough.
Two of the doctors work in St. Albans for Franklin County Pediatrics, which will close down completely. Another is leaving Mousetrap Pediatrics in St. Albans, and the fourth left Mousetrap earlier in the year and hasn’t been replaced.
The Vermont Medical Society, which is loosely affiliated with the American Medical Association, says that will leave the parents of 6,000 children “scrambling for primary health care” among the northern Vermont county’s seven remaining pediatricians.
“Everybody’s going to work together and try to make sure that these kids get the care that they need when they need it,” said Dr. Barbara Frankowski, the president of the Vermont chapter of the American Academy of Pediatrics.
At her day job, Frankowski works as a pediatrician at the UVM Children’s Hospital in Burlington. The hospital has the same financial structure as the UVM Medical Center, and her pay is shielded from reimbursement rate changes.
She said practices in her area would gladly take Franklin County patients, but she said driving south from St. Albans to Burlington is not a realistic solution because some families can’t afford transportation and others may find it difficult to drive down with crying, sick kids in the car.
Most children in Franklin County use Medicaid, the combination state and federal program that historically reimburses doctors and hospitals at a lower rate than the federal Medicare program, which itself reimburses at a lower rate than private insurance companies do.
About 70,000 children in Vermont are on some type of Medicaid, according to the Department of Vermont Health Access. Nearly 63,000 of those kids qualify for Medicaid because their parents have low incomes.
When the Affordable Care Act expanded Medicaid to more lower-middle income people, the law also bumped up reimbursement rates, largely to family doctors and pediatricians who serve many enrollees. The higher rates lasted from Jan. 1, 2013 to Dec. 31, 2014 and have not gone back up in Vermont.
Dr. John DiMichele, who works at Mousetrap Pediatrics in St. Albans is leaving to take a job in North Carolina, owned by an out-of-state hospital system, where he will be an employee with a salary instead of a part-owner whose income is based on reimbursements.
“I’ve worked in Mousetrap for 16 years,” DiMichele said. I know my families very very well. I actually enjoy what I do. It’s actually a very very difficult decision to make.”
At Mousetrap, 69 percent of DiMichele’s patients in Vermont paid with Medicaid, and he said his income went down about 40 percent this year when reimbursements went down under the Affordable Care Act. The bills stayed the same, he said.
“I think had the Legislature maintained level funding over the past couple years, we wouldn’t be having this discussion,” DiMichele said. “It’s that simple.”
Dr. Kristen Connolly, who will leave when Franklin County Pediatrics closes, wrote her concerns a letter to Al Gobeille, the chair of Green Mountain Care Board, which regulates hospital budgets and spearheads health care reform.
“I firmly believe that action needs to be taken, and soon, or this trend will continue throughout the state,” the letter said. She asked the board, Gov. Peter Shumlin, and the Legislature to figure out how to reverse the 20-percent rate cut to Medicaid reimbursements.
Gobeille said in an interview that the Shumlin administration tried to keep Medicaid reimbursement rates steady with a 0.7-percent payroll tax, but that failed in the 2015 legislative session. He said the Green Mountain Care Board should do an entire “rate review” for Medicaid in the near future.
Allan Ramsay, a family doctor who sits on the Green Mountain Care Board, said reimbursement rates for primary care are one of the things that keep him up at night, but there is no data saying doctors are leaving the whole state.
“This issue of pediatricians leaving because of a payment model that is not working for them—we don’t want that to be a harbinger of health care reform in the future, in any way,” Ramsay said. “We can’t let that happen.”
Reading the comments at the bottom of the article are always most interesting
http://vtdigger.org/2015/12/12/four-pediatricians-leave-franklin-county-blame-medicaid/#comment-268629
(Note: VT already pays a higher reimbursement medicaid rate than many states do)
FOUR PEDIATRICIANS LEAVE FRANKLIN COUNTY, BLAME MEDICAID
Four pediatricians say they’re packing up and leaving Franklin County because the Medicaid programs that insure about half of the community’s children aren’t paying them enough.
Two of the doctors work in St. Albans for Franklin County Pediatrics, which will close down completely. Another is leaving Mousetrap Pediatrics in St. Albans, and the fourth left Mousetrap earlier in the year and hasn’t been replaced.
The Vermont Medical Society, which is loosely affiliated with the American Medical Association, says that will leave the parents of 6,000 children “scrambling for primary health care” among the northern Vermont county’s seven remaining pediatricians.
“Everybody’s going to work together and try to make sure that these kids get the care that they need when they need it,” said Dr. Barbara Frankowski, the president of the Vermont chapter of the American Academy of Pediatrics.
At her day job, Frankowski works as a pediatrician at the UVM Children’s Hospital in Burlington. The hospital has the same financial structure as the UVM Medical Center, and her pay is shielded from reimbursement rate changes.
She said practices in her area would gladly take Franklin County patients, but she said driving south from St. Albans to Burlington is not a realistic solution because some families can’t afford transportation and others may find it difficult to drive down with crying, sick kids in the car.
Most children in Franklin County use Medicaid, the combination state and federal program that historically reimburses doctors and hospitals at a lower rate than the federal Medicare program, which itself reimburses at a lower rate than private insurance companies do.
About 70,000 children in Vermont are on some type of Medicaid, according to the Department of Vermont Health Access. Nearly 63,000 of those kids qualify for Medicaid because their parents have low incomes.
When the Affordable Care Act expanded Medicaid to more lower-middle income people, the law also bumped up reimbursement rates, largely to family doctors and pediatricians who serve many enrollees. The higher rates lasted from Jan. 1, 2013 to Dec. 31, 2014 and have not gone back up in Vermont.
Dr. John DiMichele, who works at Mousetrap Pediatrics in St. Albans is leaving to take a job in North Carolina, owned by an out-of-state hospital system, where he will be an employee with a salary instead of a part-owner whose income is based on reimbursements.
“I’ve worked in Mousetrap for 16 years,” DiMichele said. I know my families very very well. I actually enjoy what I do. It’s actually a very very difficult decision to make.”
At Mousetrap, 69 percent of DiMichele’s patients in Vermont paid with Medicaid, and he said his income went down about 40 percent this year when reimbursements went down under the Affordable Care Act. The bills stayed the same, he said.
“I think had the Legislature maintained level funding over the past couple years, we wouldn’t be having this discussion,” DiMichele said. “It’s that simple.”
Dr. Kristen Connolly, who will leave when Franklin County Pediatrics closes, wrote her concerns a letter to Al Gobeille, the chair of Green Mountain Care Board, which regulates hospital budgets and spearheads health care reform.
“I firmly believe that action needs to be taken, and soon, or this trend will continue throughout the state,” the letter said. She asked the board, Gov. Peter Shumlin, and the Legislature to figure out how to reverse the 20-percent rate cut to Medicaid reimbursements.
Gobeille said in an interview that the Shumlin administration tried to keep Medicaid reimbursement rates steady with a 0.7-percent payroll tax, but that failed in the 2015 legislative session. He said the Green Mountain Care Board should do an entire “rate review” for Medicaid in the near future.
Allan Ramsay, a family doctor who sits on the Green Mountain Care Board, said reimbursement rates for primary care are one of the things that keep him up at night, but there is no data saying doctors are leaving the whole state.
“This issue of pediatricians leaving because of a payment model that is not working for them—we don’t want that to be a harbinger of health care reform in the future, in any way,” Ramsay said. “We can’t let that happen.”
Reading the comments at the bottom of the article are always most interesting
http://vtdigger.org/2015/12/12/four-pediatricians-leave-franklin-county-blame-medicaid/#comment-268629
You must join this user group in order to participate in this discussion.
You are reading content posted in the Current Events . . . Group
A list of national and international resources and hotlines to help connect you to needed health and medical services.
Herpes sores blister, then burst, scab and heal.
Herpes spreads by oral, vaginal and anal sex.
STIs are the most common cause of genital sores.
Condoms are the most effective way to prevent HIV and STDs.
PrEP is used by people with high risk to prevent HIV infection.
