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Response to Divernan (Reply #2)

Wed Feb 20, 2013, 06:54 PM

4. Doctors for America: "Privatize Medicaid? Have We Learned Nothing?"

The state of Florida has instead chosen to press forward with a plan to privatize Medicaid. In 2005, then Gov. Jeb Bush began a pilot program to privatize Medicaid plans in 5 counties. This plan has been met with much criticism both from providers and beneficiaries. Concerns were raised back in 2007 by AHCA Inspector General Linda Keen regarding the planís success. Georgetown University researchers raised issued and noted that some doctors couldnít afford to provide care to Medicaid patients under these plans. The University of Florida released an analysis of the pilots in 2009 that revealed some modest cost savings but made no analysis of quality or accessibility of care.

These plans reimburse physicians at 58% of Medicaid reimbursement rates. Some of my colleagues find that seeing these patients actually costs them money. This has obviously led to low acceptance and participation by providers.

I currently participate in 5 private Medicaid plans. Four of them require paper claims for reimbursement as well as onerous authorization procedures. I currently care for a 4 year old child with recurrent seasonal wheezing that has concomitant growth delays. I have attempted to treat her with a leukotriene modifier drug. Her private Medicaid provider denied my request, insisting that I use a generic nebulized steroid preparation. I engaged in a peer-to-peer review to try and get approval (that lasted 15 minutes over the phone), after exhausting 3 levels of paper prior authorizations. The friendly doctor I spoke with apologized that the drug could not be approved and when pressed for a reason, his answer was clear- COST. My patient will have to be placed on a medication that could further stunt her growth when a safer option is available, because her privately administered Medicaid insurance plan needs to make more profit.

I am amazed at how history repeats itself. Did we learn nothing from the failed experiment of privatizing Medicare? As a reminder, Medicare Advantage programs cost taxpayers 14 percent more than traditional, fee-for-service Medicare. This additional cost did not contribute to better care for seniors. It surely lined the pockets of the insurers with big profits. The same thing will happen in Florida if we agree to let Medicaid become a private endeavor. And millions of Floridians will again be left poor, sick and uninsured.

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