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January 12, 2005

Jeb! plan: Destroy Medicaid to save it

Medicaid is essentially health insurance for low income families, children, seniors, and people with disabilities. Like health care costs in general, like private insurance, costs have been going up lately, but a big part of Medicaid cost increases is due to an upsurge in enrollment (pdf), and, in fact, Medicaid costs have risen slower than private health insurance premiums. See, during rough economic times, more folks find themselves in need of this social safety net, so more people are being served, at a less inflationary rate than would be provided privately.

Jeb! illustrates the severity of the Medicaid crisis by playing with percentages. He adds up both state and federal contributions and uses that total to achieve his 25 percent of the state budget fear mongering rhetoric. Medicaid costs are big, but 60 percent of that 25 percent is covered by the feds.

But don’t worry: Jeb! now has a plan to solve the Medicaid “crisis”, and though he’s not really sure what the plan entails, he does know that it will save the state oodles of money, because, well, because patients will get vouchers and HMOs are really great and it’s really unfair to deny them a chance to profit from the suffering of our poor.

Jeb! pooh-poohs the notion that, much like his brother’s Social Security “reform,” this privatization scheme is simply much ado to give cover to the ultimate goal of severe cutbacks or even the complete abolishment of the Medicaid program (with an added bonus of enriching campaign donors in the process), and he really hopes that no one in Florida notices that Tennessee, having started down the road to Medicaid “reform” last year, is in the midst of dropping over three hundred thousand people from it’s Medicaid Tenncare coverage right now.

Jeb! is praying that everything works out, and as soon as his spokesman Dr. Adams locks in some lucrative state Medicaid contracts, he’ll study up on the proposal and share his views with the rest of us.

Gov. Jeb Bush asked state lawmakers Tuesday to overhaul the state's ''unsustainable'' healthcare system for the poor by making it run more like a private insurance plan -- or risk drowning the state in red ink. ......

The plan, one of the most ambitious in the nation, seeks to shift the day-to-day business of managing Medicaid from the state to an as-yet undeveloped pool of insurance companies, health-maintenance organizations and physician networks who would somehow control costs without shortchanging 2.2 million of Florida's poorest and sickest residents now on Medicaid.

Bush said he didn't know whether Medicaid clients would have to pay more money out of pocket for premiums and co-payments nor did he know the cost for the entire program, which would have to be approved by both the state Legislature and the federal government. Regardless, he acknowledged that spending would likely be capped. Right now, Medicaid largely guarantees a host of budget-busting services.

Coupled with the fuzzy details, the plan's strong reliance on the private market worried social-service advocates and Democrats. They say they are concerned that Bush's proposal is a fancy and confusing way to simply cut the program and halt its growth, as Tennessee's governor did Monday, leaving 323,000 people in that state without coverage.

The state Senate's Democratic leader, Les Miller of Tampa, said he didn't have as much faith in corporate America, but noted that something needs to be done to control Medicaid costs, which have ballooned along with private insurance.

''The governor still hasn't addressed the growing trend by large, successful corporations to shift their employee healthcare costs onto Medicaid as a way of boosting their bottom line,'' Miller said. ``He hasn't told us how, in a state still struggling to account for the latest private contracting scandals, the private sector will be held accountable under his plan to privatize Medicaid; and he hasn't told us how this buffet-style plan will significantly save Florida's taxpayers any real money in the long run.''


At it's heart, Bush's proposal is simple: Rather than have 47 different programs to fund, Bush wants to eventually establish three pots of money for care: Basic, catastrophic and enhanced. Each Medicaid recipient would be assigned a ''risk-adjusted'' premium, paid by the state, based on his or her health.

Dr. Nelson L. Adams, a founder of Sunrise-based PhyTrust physicians network, was tapped by Bush to tout the reform Tuesday, but later said he wasn't sure how everything was supposed to work. Adams said he hoped the proposed reform could make it easier for minority-owned networks such as his to provide services to their communities. ''If a patient spoke exclusively Spanish, would the patient be more comfortable with a Spanish-speaking doctor and a network that has an arrangement with Sedano's [supermarkets] instead of Walgreens?'' Adams said.

Reciting a Bible passage, Adams said groups such as his would heed the call to help those to whom little has been given. The reference drew a chuckle out of the devoutly religious Bush.

''I never thought we would have scripture quoted,'' Bush said. ``Why not? We may need it.''

The SP Times has a decent primer on the Medicaid program.

The Kaiser Family Foundation has tons of useful info and background on the state budget problems and Medicaid.

Posted by Norwood at January 12, 2005 08:43 AM