dumping patients – part 2

This story looks to be a long, drawn out, protracted ordeal – PBJ & Co. have a big fight on their hands, and now it looks like LSU ain’t too happy about the arrangement. The pols in Baton Rouge should address the shortcomings in the insurance industry first before they dictate that thousands of marginalized Louisiana citizens will be dumped into the loathe-to-payout, for-profit health insurance juggernaut.

To quote a veteran, who commented on the Times Picayune story: Thank-you, Bobby Jindal for proving you’re a typical GOP shill. I realize I voted for you, but as a 2 tour combat veteran I’ve heard this tune before. Veterans and poor people are the first 2 people to ignore the needs of in an economic downturn. NOLA is now without a VA hospital and no Charity Hospital. Now you can delve into cutting benefits for the downtrodden of society! I hope the GOP recognizes you’re no savior, because I won’t vote for you on a national ticket!

Medicaid program on skids, Jindal says
by Jan Moller, The Times-Picayune
Friday November 14, 2008, 9:41 PM

BATON ROUGE — Arguing that “doing nothing is not an option, ” Gov. Bobby Jindal on Friday proposed restructuring Louisiana’s health-care program for the poor into a private insurance model that relies on managed-care principles to control costs and improve health outcomes.

“Our health-care system today is not working to help the very people it’s designed to serve, ” Jindal said at a late-afternoon press briefing to announce the Louisiana Health First initiative.

Jindal said change is needed because the state’s Medicaid program, which serves more than 1 million poor, elderly and disabled Louisianians, is on an unsustainable financial path. Whereas the program consumed about 8.5 percent of the general fund budget in 2006, it is projected to take up 21 percent by 2011, the governor said.

But details of the plan, which is contained in a 65-page “concept paper, ” remain incomplete, and the plan would need approval from the federal government and the state Legislature.

The administration had hoped to have a deal in place with federal authorities before the Bush administration leaves office in January. But the two sides are hung up on financial issues and negotiations are ongoing. “We’re not going to agree to terms (with the federal government) that are not in the best interest of the state, ” Jindal said, adding that the wrangling could continue into next year.

In the current system anyone who qualifies for Medicaid by virtue of age, income or disability can go to any health-care provider willing to treat them and the state will pay the bill. The problem, critics say, is that there aren’t enough doctors willing to treat Medicaid patients, and the providers that do participate in the program rarely coordinate among themselves to ensure that patients are getting the appropriate level of care.

And while Medicaid already covers children in families up to 250 percent of the poverty rate, the program is practically off limits to most healthy adults. Only those adults who make less than 12 percent of the poverty rate qualify for benefits.

Jindal’s plan calls for pilot programs in four regions — New Orleans, Baton Rouge, Shreveport and Lake Charles — where most Medicaid recipients would be required to choose between competing managed-care networks. The state would provide “choice counselors” to help people pick between the plans, and people who don’t choose would be automatically enrolled in a plan.

In the New Orleans region, about 129,000 people would be affected by the changes, which would not take effect until 2010 at the earliest. Besides covering those who are already eligible, the governor’s plan would expand coverage to parents and caretakers of Medicaid-eligible children who live at or below 50 percent of the federal poverty level.

The biggest change is contemplated in the Lake Charles area, where Medicaid would be expanded to cover anyone living at or below 200 percent of the poverty level: an estimated 25,000 people. Those making between 200 percent and 350 percent of the poverty level would be allowed to buy into the program on a sliding scale. It would be paid for largely with money that now pays for charity care in that area.

While some of the details are bound to be controversial, there is little disagreement among health-care providers that improved coordination of care among primary-care doctors, specialists, hospitals and other stakeholders in the health-care system is the key to making people healthier.

“These concepts are things that make a lot of sense to us, ” said Dr. Fred Cerise, who oversees the Louisiana State University-run Charity Hospital System and medical schools. “Coordinated care, doing a better job of coordinating services to get better outcomes, that’s what we do.”

But Cerise said LSU reserves judgment on the financing of the plan, which calls for using some of the money that now pays for uninsured care in the charity system to finance the coverage expansion. Taking money out of the LSU system to pay for care in other settings “is going to cause us a problem, ” he said.

It’s unclear how the state would save money, at least in the short term, as the plan to expand coverage would appear to cost the state more money than it’s now spending. The state is proposing to pay for the extra coverage in part by using money that the federal government claims Louisiana owes for past overspending in Medicaid.

The proposal faces opposition from doctors’ groups, which have complained about a lack of transparency as the state developed its proposal and favors a system that does not rely on private insurers to coordinate care. “It’s turning the lives (of patients) over to the for-profit managed-care industry and that’s what we’re opposed to, ” said Sandra Adams of the Maternal and Child Health Coalition, an advocacy group.

~ by maringouin on Saturday, November 15, 2008.

One Response to “dumping patients – part 2”

  1. You are “it”


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