An Unwelcome Medicaid Surprise


This from the Chicago Tribune:

An unwelcome surprise from the Cook County health system

What surprise could that be?  Well, remember all those people protesting why some states are not increasing their Medicaid rolls?  The argument was that the government was going to pay the state for it so why not take it?  I have even seen Facebook petitions trying to stir up support for this travesty.  Now for some hard proof.  Here are the salient points from the Tribune’s article:

  • CountyCare — that’s Cook County’s attempt to leverage federal dollars through a Medicaid managed care program — is in a heap of trouble. Expenses outstripped revenues by $21 million in the first six months of the county’s fiscal year, through May 31. The shortfall is expected to grow to $63.5 million by the end of the fiscal year, Nov. 30. That’s driving a projected $85.9 million shortfall in the 2014 Cook County budget.

  • Next year looks grim, too: Cook County Board President Toni Preckwinkle projects a $168.9 million deficit for the county in fiscal 2015, which starts Dec. 1, including a $50 million deficit in the health care system.

  • But the financial failings of CountyCare and the questionable hiring and elevation of Shannon ought to force everyone to ask: What’s going on here?

  • Raju started a major restructuring of the health system to boost patient care and reduce the demand on taxpayers to subsidize that health system. It held great promise.

  • But health officials say CountyCare is running unexpected deficits.

  • Why were they blindsided? Shannon tells us that “the population that we’re taking care of was truly terra incognita,” meaning it was difficult to predict how and when these newly insured patients — many with serious, untreated chronic conditions — would seek care. The county also hired more staff to meet demand.

  • CountyCare was designed to bring in an early haul from the federal government as the Affordable Care Act provided Medicaid eligibility for more people. It did bring a haul: The county reaped $137 million for the more than 90,000 CountyCare patients in the first six months of fiscal 2014.

  • Those patients were required to use CountyCare clinics and other facilities. That will change in January, when those patients will be free to enroll in other health plans and choose other providers.

  • That creates an unknown: CountyCare treatment is costing more than expected, but if too many patients leave CountyCare, the public health system could wind up treating only those patients with the most complex, expensive health issues, including many who have no insurance. The financial picture could get even worse.

  • “We have a health system that has not always kept up with developments, the use of technologies, different things to help us be more effective,” Shannon tells us. “We’ve been on an old-fashioned model, an old chassis. We need to change that so we have more effective and efficient clinical operations.”

  • Shannon has the opportunity now to do that. If he doesn’t succeed, taxpayers are going to be left feeling pretty sick.

This is just one city’s result.  This will happen everywhere once you expand Medicaid.  Medicaid is broken.  Doctor’s do not take it because it pays pennies not the dollar.  These patients then use the ER and the result is the above.  So, to all those people who read this and have gotten mad at their governor for not taking Medicaid money from the government, now you know why.  Expand Medicaid and the “taxpayers are going to be left feeling pretty sick”.  Actually, VERY sick.


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