[Peace-discuss] [IllinoisSinglePayer] ispc position on medicaid expansion in il

[David Johnson]

>From Doctor ( M.D. ) Anne Scheetz who is with the Illinois Single Payer Coalition, statement in regard to this latest Medicaid 
" expansion " bill " Action Alert " that Champaign County Healthcare Consumers sent out and that Jennifer Cartwright forwarded to the list.

David Johnson

" The Kaiser Foundation, whose data are mentioned in the "fact" sheet, will not give any grants to any single-payer organization. " 


  ----- Original Message ----- 
  From: Anne Scheetz 
  To: illinois single payer coalition ; chispan steer ; movetobetterhealthcare ; GPChicago at yahoogroups.com 
  Sent: Monday, February 11, 2013 7:41 PM
  Subject: [IllinoisSinglePayer] ispc position on medicaid expansion in il


    
  Someone asked the question: Based on the "Medicaid fact sheet" in the attachment, should ISPC be supporting the Medicaid expansion? Below is my reply.

  The Medicaid "fact sheet" unfortunately leaves a lot of facts out.



    a.. While Congress could have passed a simple Medicaid expansion, instead they passed the Patient Protection and Affordable Care Act, whose real purpose is to secure private and public money for the for-profit health insurance industry. The Medicaid expansion is no exception.
    b.. Illinois and other states are forcing Medicaid recipients into investor-owned-for-profit "managed care organizations" (HMO's; subsidiaries of insurance companies) that are allowed to skim 15% of what they are paid per patient; the remaining 85% is supposed to go to care, but the companies have plenty of ways to cheat on that. So far in Illinois people with disabilities have been targeted for this program. It requires people to receive care from a very limited network of clinicians who sign contracts with the insurance companies, which most clinicians refuse to do. Some of the patients affected have to travel more than a hundred miles to see an in-network provider; long-standing patient-physician relationships are disrupted. The insurance companies have onerous pre-certification and pre-authorization requirements; for instance, the physician has to submit documentation before a particular drug or a particular test will be paid for (rationing by provider inconvenience). Hundreds of thousands of decisions are subject to this requirement; I don't know how many hours of physicians' and staff time are consumed, but lots. This Medicaid privatization, like all privatization of public services, is being sold as leading to greater efficiency, higher quality, and lower cost; and will in fact lead to the opposite. 
    c.. The rules governing Medicaid expansion require the states to provide certain benefits. Illinois used to provide some benefits that are not among those required, and last year the state cut those benefits. They included for instance adult dental care (only extractions are covered now). Elderly people who have Medicare and Medicaid are now required to have pre-approval for every drug greater than four, or they will not be paid for; and many elderly people take far more than that. Again, an enormous burden that discourages physicians from accepting Medicaid patients.
    d.. The Dept of Health and Human Services recently released a proposed complex set of rules about Medicaid patients being charged co-pays for services. There are complex rules about when patients may and may not be refused services if they can't pay. These are really poor people!, so I say that this rule is simply evil. The amounts of money collected will probably not even pay for the cost of collecting it.

    e.. At best the Medicaid expansion will substitute unaffordable under-insurance (set to become the universal standard for the country) for no insurance; and it will be of some help to some institutions that take care of poor people (hence the support of the Illinois Hospital Association) and that represent a lot of poor people (like Access Living).

  There are plenty of organizations with money and influence to support the expansion, and very few that will explain or fight the harms being done.

  ISPC should not use any of our scarce resources to argue or work for or against the Medicaid expansion. Rather we should continue to work for our own proposal under which everyone would get all necessary care free at the point of service.

  The Kaiser Foundation, whose data are mentioned in the "fact" sheet, will not give any grants to any single-payer organization. 

  If you are interested, you can search for "Illinois Medicaid," "Centene," "Medicaid managed care," and "privatization" on the ISPC website to get more information.

  Anne








  -- 
  Anne Scheetz, MD, FACP
  Chicago IL
  773-486-6276
  annescheetz at gmail.com
  Organizer, Physicians for a National Health Program (PNHP), Illinois Chapter  www.pnhp.org
  Organizer, Illinois Single-Payer Coalition (ISPC)  ilsinglepayer.org
  Secretary, ISPC People with Disabilities Committee
  Corresponding Secretary, ISPC Chicago
  Hope is the belief in the plausibility of the possible, as opposed to the necessity of the probable.--Maimonides


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