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OPINION: The health-care crisis (cont.): Medicaid program focus of latest debate(Tulsa World (OK) (KRT) Via Thomson Dialog NewsEdge) Apr. 2--It's that time of year again, when reform proposals proliferate like dandelions on the lawn after a spring rain. A growing debate this year focuses on Medicaid, the joint state-federal health-care program for the needy. House Bill 2842, the Medicaid Reform Act of 2006, passed the state House and last week was heavily modified in a Senate subcommittee. More changes are likely in conference committee. HB 2842 is an impressive first-shot attempt at reforming a complicated program, but there is at least one provision that has raised concerns and that could have serious implications for both Medicaid beneficiaries and the state budget. The reform measure was the product of a task force impaneled last year by House Speaker Todd Hiett, R-Kellyville, who was hoping to find ways to cut the program's costs. Rep. Kris Steele, R-Shawnee, the task force chairman, and Rep. Doug Cox, R-Grove, an emergency room physician, have won high marks for steering a process that resulted in some significant reform proposals. But there also has been criticism, especially after the task force concluded that reducing Medicaid error and fraud rates could produce the $100-million-plus savings sought by Hiett. Critics contend billing problems aren't that serious. In addition to measures to correct billing problems, other reform provisions include: electronic medical records and drug prescriptions systems, which could help reduce errors and save money; a tiered reimbursement system for nursing homes which would encourage them to improve quality of care and obtain liability insurance; a disease management system which could help patients with chronic diseases control their conditions better, which would result in better outcomes and potentially lower costs; study of alternatives to long-term care that could help more elderly people stay in less costly settings, and measures to encourage use of primary-care services for health-care needs rather than emergency rooms. While most observers agree the above steps could be helpful, there is disagreement over one of the bill's central provisions: the creation of a pilot program that would replace the existing guaranteed-benefits system with benefit packages provided by commercial insurers. The concept to involve the private sector more in government-sponsored health-care programs is part of the "patient empowerment" movement. In general, the idea is to give consumers more control but also to encourage more appropriate usage of services, sometimes through increased cost sharing. But advocates insist that this theory is based on faulty assumptions and could backfire, resulting in even higher costs and poorer health-care outcomes. Only two other states are moving toward increasing private-sector involvement in Medicaid, and neither has yet implemented such a system. In effect, Oklahoma is heading into uncharted waters. While there may be widespread belief that Medicaid beneficiaries use too many services and that their care is more costly than privately insured care, research suggests otherwise. Some data show that Medicaid programs are more efficient and that their costs aren't rising as rapidly as private health-care programs. Research conducted by the Center on Budget and Policy Priorities found that Medicaid costs were 30 percent less for adults and 10 percent less for children than private health insurance. The 2001 per-capita costs of serving an adult on Medicaid were $3,145, compared with $4,410 for a privately insured adult. For a child on Medicaid, the per-capita cost was $719, compared with $795 for a privately insured child. The CBPP also found that Medicaid per-person spending grew more slowly from 2000-2003 than spending in other programs: 6.1 percent for Medicaid; 6.9 percent for Medicare; 10.6 percent for privately insured enrollees, and 12.6 percent for employer-sponsored programs. It is accurate that Oklahoma's Medicaid program, administered by the Oklahoma Health Care Authority, has experienced rising costs, but much of that increase is due to the addition of more beneficiaries. Medicaid spending in Oklahoma grew 64 percent between fiscal 2000 and fiscal 2005, from $1.7 billion to $2.8 billion, but enrollment grew 35 percent during that period. Critics of expanding private-sector involvement in Medicaid argue that the change could only increase administrative costs. In 1999, Oklahoma's Medicaid administrative costs were about 6 percent of total expenditures, compared with the U.S. average that year of nearly 12 percent for private coverage. There also is concern that private-sector plans would not provide the range of treatments needed by some Medicaid patients, who can have serious, multiple health-care needs. If private plans cap services at a certain dollar amount, or increase out-of-pocket costs to beneficiaries, they might decide to delay or avoid getting services. That could lead to more serious, more expensive problems and even more emergency room use. Perhaps the biggest problem with Medicaid reform, however, is that it in effect misses the point. What's feuling Oklahoma's health-care crisis isn't so much Medicaid costs but the costs of treating those with no insurance at all. Sen. Tom Adelson, D-Tulsa, former state secretary of health, has introduced modifications intended to address more aspects of the uninsured problem. He hopes to raise the age limit children can stay on Medicaid to 23 if they are enrolled in college, which could affect more than 15,000 young adults; to expand the premium-assistance program allowing private insurers and individuals to buy into Medicaid; and to mandate a charity-care policy requiring hospitals to provide discounts to low-income uninsured citizens. Adelson also wants to make sure any pilot program for Medicaid recipients provides a level of care comparable to what they get now, and to protect health-care providers from any cuts in reimbursements. "If you want to deal with the health-care crisis, the issue is access to care and it's primarily the uninsured, and to take an existing covered population and put them into perhaps a thinner plan is not going to do anybody any good," he said. "I don't see how anyone who wants to do anything about the health-care crisis can overlook the uninsured." ------------ Janet Pearson 581-8328 [email protected] |