Kentucky: A Preview of ObamaCare?
Patients complain of being denied treatment or forced to travel long distances to find a doctor or hospital in their plan’s network. Advocates for the mentally ill argue the care system for them has deteriorated. And hospitals and doctors say health plans have denied or delayed payments.
Experts warn that what happened in Kentucky should be a cautionary tale for other states that rush to switch large numbers of people in Medicaid, the state-federal program for the poor and disabled, to managed care in hopes of cutting costs and improving quality. Nearly 30 million Americans on Medicaid now belong to a private health plan, as states move away from the traditional program that paid doctors and hospitals for each service they provided…
In May, Democratic Gov. Steve Beshear announced that the state would expand Medicaid under ObamaCare to about 308,000 more Kentuckians, who will be placed in managed care plans. (Kaiser Health News)
“The Kentucky case is a harbinger of what can happen when states don’t allow enough time and devote sufficient resources to strengthen the Medicaid agency’s oversight capacity and systems — or develop strong contracts and care monitoring systems from scratch if they haven’t contracted with managed care plans before”
Basically, spend more.
That’s what many would want, although not a good solution either.
“Kentucky is largely rural, with a population that has serious health care needs. Last year, its national overall health ranking was 44th and it ranked 50th in smoking and cancer deaths and 40th in obesity”
It doesn’t sound like good news for Kentucky residents.
Depends on who you are, a lot of these people are going to get their cake and eat it too (live an unhealthy lifestyle and get expensive care for a fraction of the price). Maybe we should all be more like Kentucky.
That’s a big assumption, Dewaine.
I just mean that not having to pay your own health care bills removes some of the disincentive of living an unhealthy lifestyle. Do you disagree?
It sounds like part of the reason is the rushed switch over; so shouldn’t that mean that the situation will improve?
I’d keep up with Kentucky, because we may see the benefits first too.
Certainly. As it settles in it should get better, although it won’t ever be good.
A cursory read will cause some people to believe that the problem is the free-market, but that isn’t the case. This is government-on-government crime.
This is a more complex problem. Medicaid won’t disappear, this post is about FFS vs MMC.
By most accounts, Medicaid managed care provides better access to care than traditional Fee-for-Service (FFS) Medicaid. The problem with Fee-for-Service Medicaid has always been that many states set physician fees so low enrollees have a difficult time finding doctors who will treat them. Medicaid managed care tends to integrate physicians and hospital care to create appropriate incentives (i.e. plans that provide poor access to care suffer higher numbers of more costly Emergency Room visits).
The key to making managed care work for Medicaid enrollees is appropriate planning and budgeting. States that are unwilling to adequately fund FFS often want managed care plans to also operate on a shoestring budget. That makes it difficult for enrollees to access care, similar to FFS Medicaid.
I second Devon Herrick’s comment, and add the following:
What is never discussed in these articles is the degree of choice the Medicaid beneficiary has. That is, if a managed-care plan wins a contract for a certain population within a county, I would not be surprised to see the type of outcome described. The reason is that there is no choice.
If the county allows individuals a choice of managed-care plans, these experiences will surely be improved. I have seen this in some California counties, but am not aware of a national survey reporting this degree of choice.
Nevertheless, if there is not enough paid to cover providers’ costs, there is no solution to that, either in managed care or FFS.
It’s incumbent upon states to control Medicaid costs some way, and managed care is one of the options available. But if Kentucky is expanding Medicaid to healthy adults above 100 percent of the poverty level, they should consider not extending Medicaid benefits to them, and instead send them to the health exchange, where federally subsidized insurance is available.