Interesting take on how MCOs are ripping us off.
12/31/15 Mpls. Trib.
AFFORDABLE CARE ACT AND MNSURE
Commentaries failed to mention our managed care organizations
I was impressed with the two divergent views of the Affordable Care Act on Dec. 27 (“The ACA in action,” Opinion Exchange). One piece by Allison O’Toole extolling the virtues of MNsure (“Trending up: For MNsure, the lights have turned from red to green”) and the other by Stephen Parente (“Trending toward terrible: Expect higher bills, fewer covered”) prophesizing the collapse of the ACA. How could two knowledgeable people look at the same thing and come to such wildly different conclusions? The answer is found in the fact that both of them ignored the single most important issue impacting the future of American health care: the use of private managed care organizations to discharge what is now clearly a government program. Notice I didn’t say “insurance” companies. There is no insurance function in these transactions anymore. The government — state and federal — and self-insured employers pay for the cost of health care, and these managed care organizations act only as disbursement agents, spending other people’s money. This explains why prices keep going up. If you’re paying bills with someone else’s money and there is no oversight or audit, then it’s easy enough to inflate the actual costs and pocket the difference. This is exactly what these managed care organizations have been doing.
Don’t take my word for it. Look at the Segal report that the Dayton administration commissioned. In March 2013, Segal said that the trend methodology that relied solely on managed care organizations’ self-reported data produced “a systemic overstatement of the trend, causing the program to exceed targets over time.”
Still skeptical? Look at a federal case in Michigan in 2014 (Hi-Lex vs. Blue Cross of Michigan). In this case, the courts found that “regardless of the amount [the managed care organization] was required to pay a hospital for a given service, it reported a higher amount that was then paid by the self-insured client.” In other words, the managed care organization inflated its reported costs of health care in order to be paid more money.
We have created a system whereby third-party administrators benefit by inflating their reported costs of health care. The feds think that the state audits this, but the state does not because it regulates only the business of insurance — and this isn’t insurance. Thus, these managed care organizations are free to inflate and misrepresent costs. Furthermore, they are rewarded with subsidies and increased profits for doing so. And we passed a law requiring Americans to buy a useless, overpriced product from these managed care organizations or pay a fine to the IRS. High-deductible plans are useless and overpriced. They provide the illusion of insurance with no meaningful coverage. This explains why costs keep going up and why the ACA in its current structure and administration is unsustainable. Most people inside health care have some understanding of these issues, yet apparently choose to avoid discussing them, lest they offend those abusing the system.
David Feinwachs, St. Paul
The writer is a former lobbyist for the Minnesota Hospital Association.
No comments:
Post a Comment