House Republican Leaders, Senate Republicans Reject Katz-Saviello Medicaid Expansion Bill

In 2006, Ken Lindell and I presented an alternative to Dirigo ..”Tuesday, January 10, 2006, MAINE VOICES: Rep. Kenneth Lindell and Frank Heller;

Maine has better options than Dirigo .Copyright © 2006 Blethen Maine Newspapers Incthat addressed the same issues Bennett Katz has in his combo of expanded Medicaid and Managed care.

Remember the premises on which Maine-care was ‘sold’ to a skeptical public was that it would relieve E.R. crowding,make poor people healthier, reduce the hospital debt from no-pays and free loaders.

BUT after created E.R. use skyrocketed, along with hospital debt from unpaid Medicaid bills stalled by a no-pay Dem. administration which considered Hospitals as ‘cash cows’ who would never run out of milk.

The E.R. overload became such a problem, esp. when combined with the Non-payment of MAINECARE debt, that a study of Hospital e.r. utilization was commissioned from the Cutler Institute, Muskie School and released in 2010. (http://muskie.usm.maine.edu/Publications/PHHP/Maine-Emergency-Department-Use.pdf)

Its findings documented the visits in 14 areas could have been prevented were alternative facilities available….as we all know, conventional facilities are rarely open on weekends when the E.R. is heavily used, esp. by sick children.

There is a litany of complaints of long waits, etc. for conventional facilities; and having visited Bowdoin Medical Group on weekends, know they make frequent referrals to the E.R. for diagnostic scans and lab workups. Walk in clinics rarely have CAT and sonogram machines or a round the clock trained staffer.

The E.R. is always open, and ability to pay is determined AFTER you receive treatment at Mid Coast Hospital.

Even more revealing is this study found that “insurance status” wasn’t linked to high or low ER use. The rurality of the area served was critical, you always know the hospital has every kind of service available and even helo pads.

So the solution is not more insurance coverage; but a redesign of the health care system so that full service facilities are located in rural and poorly served areas. The cost of ‘Quick Care’ clinics to ‘replace’ a hospital is unknown, nor their impact on weekend flooding of E.R.’s.

KATZ assumes that having more people insured would drive down the costs of health care, so did expanding eligibility to 150% of poverty level reduce the costs or demand for hospital services?

It doesn’t look like it based on the increase in costs of hospital care as they expand expensive ancillary services like labs and diagnostic centers and ‘on-call’ specialists.

I like to compare it to the public schools. For years we heard that paying teachers more money would improve education. So we did, and the scores didn’t budge, and in fact, the SAT’s are sliding backwards to well below mean.

Pour more money into hospitals and you may well see an increase in the cost of care….I would almost guarantee it.

The ultimate objective is whether expanding the numbers of the insured will make them healthier and in turn reduce the cost of health care.

Maybe it would or maybe it wouldn’t…a thorough study must be done. A decade ago, there was considerable support for annual mammography; and now a study seriously questions the need and in turn the cost.

I took cancer and Maine now ranks 2nd or 3rd in the U.S. for cancer rates. So if you increase insurance coverage will cancer rates go up from more early intervention; or will costs go up since cancer prevention is fairly expensive; or will the rates go down while costs go up and by how much?

I fell in the back yard one evening in December and hit my forehead on a paving stone. Went to Parkview E.R. since I knew they were open and had a full suite of services available….smart move, since they had a CAT scanner to see if there were any brain bleeds; the down town walk in clinic probably didn’t so rather than drive down town, bleeding, to find this out mean’t ‘go to the hospital’.

The bill came back for $3,000 for what is now a nearly invisible scar above my eyebrow…DERMABOND and stitches. no brain bleed! Could it be cheaper?….maybe; but would it be better? …I doubt it.

I wish Bennett well in his compromise to increase insurance coverage but I really doubt if health costs will come down, the health of an expanded population of low income people will improve; and the hospital will cease to be the place of first resort for parents of sick children.

Managed care is the great panacea; I am in a managed care group practice and don’t see any incentive to reduce costs; nor am I happy with a somewhat arbitrary assignment of a primary physician who is a ‘contract doc’ and could be snapped up like a sports player—he’s young and very good.

Beth, read the Kentucky analysis:

“The report found an eight percent drop in hospitals and other healthcare providers serving Medicaid members. The most significant change was related to general hospitals, which saw a REDUCTION of 586 providers, or 57 percent, since the inception of the program through February.

Only seven of those 586 providers are in Kentucky, but the report found that 310 are in the seven border states. That could affect Medicaid members living in or around border counties.”

WOW talk about a hit on the providers serving the poor! Confirms my suspicion that ACA is dividing the health care provider system into those who are in the govt. system and those who are opting out for a private, for pay practice. We will have to import providers from Asia, Africa and Cuba if this keeps up.