jsonline- Guy Boulton: The system of managed care for the almost 300,000 children and adults covered by BadgerCare Plus in southeastern Wisconsin may be crumbling. The state cut payment rates to the managed care organizations by 11% in 2011 and then again this year as it struggled to balance its budget.
At issue: At least three of the four organizations managing the BadgerCare Plus program in the region say they are losing money on it. One of the organizations, United HealthCare, is dropping its contract with the state at the end of this month. Now a second, Molina Healthcare Inc., is warning it may soon have to do the same, for the same reason.
I’m on Badgercare, so I’m familiar with the new rate
structure, one that already charges larger co-pays. If they get any larger,
there will be only a slight difference between private rates and Medicaid’s. And rate
increases are already on their way. This is what will happen to block granted
Medicare plans pushed by Republicans too.
The Wisconsin Department of Health Services said it is working to develop rates for next year to ensure that adequate networks are in place. BadgerCare Plus, a Medicaid program, covers families with children under 19 that have incomes of less than 200% of the federal poverty threshold - or about $46,100 for a family of four. By federal law, the state must pay the health insurers rates that are based on their expected costs.
And that apparently isn't happening so, I guess you could
correctly say, the Walker Authority is breaking the law, again.
The government insurance doesn't pay dollar for dollar for coverage like private insurance does. For example, Medicare recently dropped its payments to help save money but this doesn't bring down the cost of health-care. My mom is on medicare, but her secondary insurance which is suppose to cover what medicare doesn't pay went up by 800 dollars under Obamacare which was passed back in 2010. Here is what I think the problem is, you don't care if a place charges 600 dollars for an MRI or 3000 dollars. Why? It's not your money! You don't care if a doctor costs 100 dollars or 700 dollars per visit. It's not your money, so when you look for health-care services the last thing you would think of would be how much the cost is and is it worth it in terms of quality. Back in the 90's one hospital charged 35,000 dollars for surgery, another 70,000 dollars, and both were highly rated so which do you think would really save money, the government lowering its payments to limit raising costs or you making wise choices? There are agencies that would help the elderly in case your wondering how some of them would be able to choose great health-care at a lower cost...
ReplyDeleteI think you missed the point, Governor Jailbait has deliberately cut the payment rate to the point where the private sector doesn't want to participate. You know, the vaunted, omniscient private sector which is never wrong?
ReplyDeleteYet you say the problem is careless sick people who aren't good consumers. You're living in a dream world.
To Mike: It would have been nice it those private sector insurance companies negotiated lower health care services instead of their customers. After all, isn't that why they're the middle man, to shop and negotiate for us? But they didn't do that, and that's the wonder of the free market system we have in place. Think about what you're saying...
ReplyDeleteGareth..great point and just what Walker intended to do. Oh we love the infallible private sector.
Back in the old days (the late 70s, early 80s), health care costs were partially controlled by government limiting the number of entities providing particular services, through the Certificate of Need process. Hospitals and clinics had to demonstrate the need for costly machinery and clinics (MRIs, heart care, etc.) based on the population. So if the hospital didn't have the latest gadget, the doctor was less likely to call for the test.
ReplyDeleteBefore "competition," we didn't have HMOs in the same city spending great sums to build clinics kitty corner from each other just to gain market share for the coming year. The Certificate of Need process would have required the HMOs to demonstrate they had the patient population first, then allow the construction.
Our insurance dollars should be spent for health care and the associated administrative costs. Capital costs need to be carefully controlled, and they are totally uncontrolled in the current environment.
What the Walker administration is doing is shameful, but they are beyond shame. Once again Dennis Smith and Scott Walker demonstrate that they care not for the average citizen but for the corporate contributor.
Leading up to when Scott Walker was elected in November 2010, Walker's handlers searched to find someone to fill the job to lead the state Department of Health. Dennis Smith was hired because he had the knowledge and involvement in health care at the national level that worked for the conservative Heritage Foundation.
ReplyDeleteSmith in early 2011 went about revamping the workings of healthcare for Wisconsinites under Scott Walker.
Cutting health care money to Government-run programs is Dennis Smith's specialty (just ask his secretary, who recently became embroiled in a sex scandal).
Here are some other documents to show you just how Dennis Smith has worked for Walker:
http://health.burgess.house.gov/uploadedfiles/2009caucusreport.pdf
http://thf_media.s3.amazonaws.com/2010/pdf/wm_2744.pdf
http://s3.amazonaws.com/thf_media/2009/pdf/wm2712.pdf
These are hard to enjoy, but give a good indication of what Smith has in mind for Wisconsinites.