Legislature chafes at Medicaid expansion, ponders cost cutting
As a Democratic Congress looks more and more likely to expand Medicaid eligibility – and therefore increase costs for states (more here on the $1 billion estimate) – the Republicans who control the state Legislature are chafing and talking behind closed doors about how to manage costs.
The Republican solution: HMOs. Or managed care. Or home care. Or integrated care. Or whatever HMO-lite solution that would cap expenditures, bring more predictability to Medicaid and end the fee-for-service model of allowing recipients to go to the Medicaid doctor of their choosing without having a gatekeeper/doctor who provides primary care and steers them to the right therapist or physician depending on their need.
Right now, all eyes are looking north, to Georgia, where Medicaid is managed by HMOs.
“It could be the Georgia model, or any other type of model,” said House Speaker Larry Cretul. “There are a lot of discussions going on.”
What does Cretul prefer? He’s not saying. “I want the members to work through the process.”
The Senate’s Republican health budget chief, Durrel Peaden of Crestview, is a physician and doesn’t like the managed-care model. “Managed care manages costs. It doesn’t manage care,” Peaden said.
But future Senate President Mike Haridopolos said “everything’s on the table.” The Indialantic Republican wants the federal government to give the state more of a say in managing Medicaid. It’s not likely. Especially considering Haridopolos’ statements in a health appropriations meeting earlier this month where he noted some Medicaid recipients receive better insurance care (at no extra cost to them) than people in the private market.
“It’s better than some HMOs,” Haridopolos said.
This morning, he met with a dozen health industry lobbyists to learn more about what they want, what they can do and what they think.
One thing some big HMOs like Wellcare don’t like: former Gov. Jeb Bush’s Medicaid reform plan that is getting off the ground in Broward County and the Jacksonville areas. Though it relies on managed care and an end of fee-for-service, Medicaid Reform seeks to create numerous networks of doctors, hospitals and primary care physicians. It also assigns more specific dollars to recipients based on their health, which makes it more difficult for insurers to keep only healthy (and therefore profitable) patients while offloading the sicker (less profitable) recipients on the private market.
Left untouched, Medicaid could drive a $1.6 billion hole in next year’s budget, though the U.S. House’s health reform package would help alleviate that gap. However, the House health plan by 2016 could cost the state $1 billion more.
While Republicans are railing against the deficit, they can blame themselves. They diverted about $1.7 billion out of the program last year to fill other holes in the budget.
The griping over Medicaid is nothing new from the Legislature. Last year, some Republicans held up a fist of protest over the stimulus money. They held the other hand open to accept only the stimulus money in a pay-me-now moment of real budget politic.