Saturday, December 06, 2008


Hawaii’s most vulnerable forced into Medicaid HMOs run by mainland for-profits—Legislature to investigate why

by Larry Geller


(cartoon copyright Hawaii Coalition for Health, used with permission. Other cartoons by John Pritchett can be found here.)

HMO’s don’t provide health care. Doctors, nurses, hospitals and even your acupuncturist provide health care. But not HMOs. They make money in various ways, including some that don’t contribute to health care at all. For example, by denying claims. Or if there are no physicians near you in the plan, they obviously won’t be paying for services you can’t get.

For some inexplicable reason, the Lingle administration has decided that Medicaid services should be provided under a new plan called QExA (I call them Al QExA, since they have got some people absolutely terrified over what will happen to them in February, when this new scheme kicks in). As a Star-Bulletin story points, out, they may have good reason to be scared:

Both companies given contracts–WellCare Health Plans Inc., based in Florida, and UnitedHealth Group Inc., based in Minnesota–have had trouble recently. WellCare is being investigated by federal and Florida authorities about possible government overpayments. In April, UnitedHealth was among a group of insurers being scrutinized by the New York attorney general in another fraud investigation. [Star-Bulletin, Medicaid clients have reason for concern, 6/20/2008]

The old way was fee-for-service, that is, anyone just went to their participating doctor and the state paid the doctor. The program was administered by local (Hawaii) non-profits. Under QExA, two out-of-state for-profit HMOs will try to sign up physicians and compete for patients to join their plans. But patients and physicians have been slow to join up. I don’t know if any hospitals have signed up yet, and it’s almost February. Kaiser has said they won’t sign on. Anyone now served by Kaiser under Medicaid will have to find new doctors. If they can.

Suppose someone on a Neighbor Island needs to see a specialist, but the specialists choose not to participate. Or suppose the specialist is in the other plan, not the one you joined. How about an older person who sees several doctors, but some are in one plan and some in the other? If someone wanted to destroy a healthcare system, they could not do better than this.

Besides, who would want to belong to an HMO anyway, if they didn’t have to?

I guess the question for me is why did the Lingle administration do this? There was not much broken the way things were, and now state money will be shipped to mainland vendors. And get this: the state plans to reimburse their excise tax to them! Yup, corporate welfare for fat private corporations. Can that even be legal? And isn’t the state facing a tax crunch due to the recession? What’s going on here?

There will be a hearing on December 9 at the State Capitol to investigate this. If you are concerned about Al QExa taking over Medicaid (and what’s next?), please check out the hearing notice and maybe submit some testimony, it’s easy. Tags: , , , ,


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