Mandated Charity

Model in Utah May Be Future for Medicaid | NYT | 2.24.05

SALT LAKE CITY - Anyone looking for clues as to how the Bush administration might overhaul the Medicaid system should come to Utah and read the fine print of Tony Martinez’s health insurance plan.

Mr. Martinez, 56, was homeless and without any health coverage a year ago. Now, under an experimental plan of partial insurance devised under Michael O. Leavitt when he was governor of Utah, Mr. Martinez can see a doctor or go to the emergency room for only a small fee.

But he and his wife, Lisa, are not covered at all for the potentially catastrophic costs of extended hospitalization or specialty medical treatment, from dermatology to oncology. For those services, they must rely, as they did when they were homeless, on charity. …

In Utah, Mr. Leavitt’s plan departs from the traditional Medicaid program on two main fronts. First, it spreads out a lower, more basic level of care to more people, and reduces coverage for some traditional beneficiaries by imposing co-payments for services. And second, it relies on the generosity of doctors and hospitals to provide specialty services free of charge. …

Incredible! Will take a rather homogenous state like Utah, one-third the population of Los Angeles county, and use that as the “test bed” and role model for Medicaid reform. The problem with this scenario is they didn’t bother to put the canary in the mine to see it would survive. What will this do?

Lets see:

• More will be covered with basic services (for less, remember Medicaid reform is all about decelerating the cost over time)
• Specialty care and catastrophic/extended care will be shifted to the private sector
• EMTALA will serve as an ever greater stick for governmental unfunded mandates
• What Medicaid dollars went to specialty care and catastrophic/extended care will directly affect those providers of services—driving up the demand for those left on the field and able to play
• There is a host of unintended consequences just waiting to pop up