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Medicaid debated

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The Medicaid debate between the two candidates continues with two thoughtful pieces. The first is an editorial from the Post-Dispatch.

But the deal also would carry risks for Illinois taxpayers. If Ms. Topinka can’t cut spending as she anticipates — if, for example, a softening economy allows more people to qualify for Medicaid, or some of the changes she plans don’t produce the savings she hopes — state taxpayers would be on the hook for an even larger share of Medicaid costs. That, or Medicaid eligibility would have to be slashed, and thousands of people would lose coverage.

Ms. Topinka plans to get savings using tactics applied in Missouri by Gov. Matt Blunt, such as stepped-up enforcement to catch people fraudulently applying for Medicaid and asset tests for some health care programs. Those changes produced savings in Missouri, but far short of what was predicted.

Ms. Topinka also wants to increase the number of Illinois Medicaid patients in managed care. That’s probably not a bad idea; with just 9.6 percent enrolled, Illinois ranks 48th of 50 states. But managed care is no magic bullet, even in the private sector. Medicaid patients are sicker and have more chronic illness than those with private insurance.

Finally, Ms. Topinka wants to reduce the number of Medicaid babies born prematurely or with complications. About one-third of the births paid for by Illinois Medicaid fit that profile. Getting the number down is a worthy goal, but it has proven difficult. Ms. Topinka says she’ll do it by creating a database to link pregnant Medicaid patients with resources available through the federal Women, Infants and Children program. That may make some difference, but not much and not soon.

In the real world, saving money means spending less than we do now. That’s rarely true in health care, and it wouldn’t be true with Ms. Topinka’s plan.

And here’s one from Crain’s.

The governor wants to spotlight his signature All Kids health care program, which hinges on savings from Medicaid. Ms. Topinka â€” running as a fiscal reformer â€” hopes to wring $2.3 billion in savings from the Medicaid system by requiring most of the state’s 2.1 million Medicaid recipients to enroll in health maintenance organizations (HMOs).

Ms. Topinka’s savings estimate is 53% higher than a figure cited in a report last year â€” a study Ms. Topinka has used as a model. A campaign spokesman says the higher estimate assumes a more aggressive rollout of the HMO system than recommended by the Lewin Group, a state-funded consultancy.

A mandatory HMO model would face fierce opposition from hospitals and doctors, who fear disruption of the entrenched funding system that dictates the flow of federal Medicaid dollars would mean less reimbursement for them.

“The financial underpinnings of the state’s Medicaid program would be jeopardized,” says Elena Butkus, vice-president of finance at the Illinois Hospital Assn.”

posted by Rich Miller
Monday, Sep 11, 06 @ 9:12 am

Comments

JBT should be talking about using state tax dollars to expand coverage to the uninsured
not cutting coverage. The concept should be, we spend billions, let’s use it better and cover more people, at least on a basic level. Let’s have guaranteed access for all Illinoisians, in a state where one million adults lack health care coverage because of the lack of affordable basic insurance.

What state does she think she is running in?
This is the state where Blago may well win re-election because of the hype surrounding his
skimpy little Allkids program. Although the program has obvious flaws, including the possibility for serious fraud, the response from the state’s residents has been overwhelmingly positive.

It’s too late now, but her mismanagement of this issue could lose her the election without some serious reframing.

Again, nobody in Illinois cares how much big social programs cost. Nobody except a few right wingers. The money is there and everybody knows it…it is just a matter of allocation and management. And management is CLEARLY Blago’s weak point.

Comment by Cassandra Monday, Sep 11, 06 @ 9:47 am
First, full disclosure; i am a consultant to a medicaid managed care organization.

With that said, I think the projected savings probably could be achieved. The MCOs spend a big chunk of their medicaid revenues on marketing, both on new enrollments and because of the “churn” allowed by the present voluntary program.

A mandatory managed care program would eliminate those marketing costs. I think many MCOs could and would take medicaid lives at a significantly lower rate than they are being paid now if their marketing costs went away.

The Hospital Assn would definitely be opposed. I don’t know about the Medical Society, though. I’m not sure they represent that many of the medicaid docs any more.

Comment by steve schnorf Monday, Sep 11, 06 @ 9:49 am
Both candidates are not telling us the ugly truth. Both pretend that there is some magic bullet that only they possess that makes all these problems go away.

Even if cornered, neither candidate will admit the truth. Both will offer optimistic scenarios. Neither will want to tell voters that there is no way we can give away free health care to anyone whenever they need it. It is impossible.

Insurers don’t even go as far as Blagojevich promises. Blagojevich has made impossible promises no one believes, just to get re-elected. Topinka is doing the same.

Political advisors are telling both candidates that since seniors vote and decide who will be the next governor, that they need to be told a stack of promises.

Seniors know there is no such thing as free health care, but want to believe that government can somehow provide it. Democrats know there is no such thing as free health care, but want to believe that the rich can be taxed to make it happen. Republicans know there is no such thing as free health care, but want to get elected.

Bottom line - everyone is a liar on this issue. What I am looking for is a leader that will not promise so many freebies they bankrupt Illinois further, destroying what little business growth is left.

Comment by VanillaMan Monday, Sep 11, 06 @ 9:50 am
Of course there is no such thing as free health care, except for the so-called poor.

The problem in Illinois is that there is no guaranteed access to reasonably priced health care for each citizen. The so-called poor get free Medicaid, Medicare covers the elderly (at a price) and now kids can get reasonably priced care through All-kids. It would not be that difficult to reconfigure the system to provide, in conjunction with the private sector,
guaranteed access to reasonably priced health care for all adults as well. All it takes is political will. The Dems will find the political will sooner or later if JBT sits back and lets them win. But either candidate could do it easily and it’s JBT’s issue to lose, especially with all that silly carping about Medicaid fraud.

Comment by Cassandra Monday, Sep 11, 06 @ 11:47 am
oh, definitely the MCOs are masters of marketing throwing out freebies to hopelessly confused Medicaid recipients. Mandatory enrollment would be better and prohibit the switching back and forth that happens when a client gets in a plan they don’t like.
and JBT’s plan–we already have asset, income tests. ask an overloaded caseworker. and the reduction of premature births-that’s about environment, decisions made by the expectant mother, etc. but maybe JBT can get some buses to personally escort all expectant mothers to their doctor visits, the grocery store, distribute prenatal vitamins, etc.–in other words, micromanagement

Comment by anonymous Monday, Sep 11, 06 @ 6:54 pm