By Dr. Anne Scheetz
About 200 Illinois health advocates and service providers attended the "Medicaid and Budget Advocacy Summit" Friday March 6th and vowed to ramp up pressure against Republican Gov. Bruce Rauner’s proposal to slash the state’s Medicaid program next fiscal year by $1.5 billion.
I attended as an observer on behalf of Physicians for a National Health Program (PNHP) Illinois and the Illinois Single Payer Coalition (ISPC). All of us know that a strong response to Rauner’s cuts is needed, but the response this group is organizing is, to my mind, profoundly disquieting for several reasons.
The participants discussed the damage that will be done by Rauner’s proposed cuts. But they failed to discuss the root problems associated with Medicaid managed care, especially the large and corrupting role played by for-profit health insurance companies.
Key presenter Samantha Olds Frey, Executive Director of the Illinois Association of Medicaid Health Plans (IAMHP), introduced the false narrative promoted by the health insurance industry and their spokespersons in government: for-profit managed care as the solution to quality and access problems under Medicaid. This is not surprising given that IAMHP includes most of Illinois' largest health insurance companies, many of which now receive state funding for enrollees in Illinois’ Medicaid managed care plans.
Managed care in fact makes coordination of care not better but more difficult. Problems reported by people enrolled in these plans include lack of choice about whether to enroll in managed care at all, narrow networks that exclude patients’ preferred providers, lack of access to teaching hospitals, inaccurate provider lists, lack of appointments, lack of knowledge and high turn-over among care coordinators, delays in care, and increased bureaucracy.
These plans are being pushed around the country by the insurance companies, which see them as profit opportunities. The potential for expanding Medicaid managed care is the real reason for the Medicaid expansion.
Samantha Olds Frey is one of the government-industry revolving door beneficiaries so prevalent in US politics. Prior to serving as executive director of IAMHP, she served as Illinois House Speaker Michael J. Madigan’s Human Services & Medicaid budget analyst. During that time, she helped negotiate and craft the Medicaid Reform Act of 2010, the $2.7 billion Medicaid reform package known as the SMART Act of 2012, and the Medicaid Expansion package authorized by the Affordable Care Act in 2013. [1]
Of these reforms, Nadeen Israel of EverThrive Illinois, formerly the Illinois Maternal and Child Health Coalition, noted, according to Ellyn Fortino reporting in Progress Illinois, "… as a state, we actually cut the Medicaid program in 2012 by $1.1 billion.” She added, “That was the largest cut that any state has ever made to their Medicaid program in one year…" [2]
The Medicaid reforms designed by Olds Frey also forced recipients into HMOs (managed care), most of which are run by for-profit insurance companies. The ACA’s Medicaid expansion gave them still more captive enrollees.
Olds Frey did speak of the need to increase revenue instead of cutting again. But under the current Medicaid system, a portion of any new revenue will likely go to private insurance profits, not to improvements in care.
Olds-Frey’s career resembles that of Elizabeth Fowler, who was an executive of the giant health insurer Well Point, now called Anthem, before she drafted and helped to implement President Obama’s Affordable Care Act (ACA). She then returned to work for the private industry she had enriched. [3]
In the final plenary session, John Bowman from the Shriver Center reinforced Olds Frey's misleading message by saying that Illinois has been moving in the “right direction” with Medicaid--that is, by forcing people into managed care. Bowman also said that the best way to bend the cost curve is to "keep people healthy." This is another example of a false narrative--everybody dies, everybody is sick (except those who appear completely well until they suffer sudden death) for at east some period of time before dying. The best way to bend the cost curve, as proved by many other countries, is to make health care a human right and to get rid of administrative waste.
It is also important to consider what was left unsaid at the summit. No one acknowledged that the Democrats could and should have crafted, fought for, and passed a revenue solution while they controlled both the governor's office and the General Assembly. No one said that the Black Caucus members who refused to support the 2012 cuts were right, nor apologized to the Medicaid recipients who have been harmed by the cuts. Instead, Olds Frey presented the cuts as necessary at the time.
No one acknowledge the many harms to people who have been forced into Medicaid managed care plans, even though advocates have spoken out about the problems many times.
Nor did anyone acknowledge the enormous cost of yearly Medicaid redeterminations [4], nor the numerous errors in this process, nor the state's attempted privatization of the redetermination process and the money wasted on that failed effort; nor did Olds Frey or anyone else apologize to any of the people who have been harmed by this.
Summary and Conclusions:
• This Protect Medicaid coalition is under the control of the state Democratic Party leadership. The advocate organizations that have signed onto this coalition will justify this as strategically necessary.
• For the Democrats this is not about the people who benefit from these programs-- if it were, they would have behaved much differently during Quinn's governorship. This is about a fight with the Republicans for political control, donations, and industry jobs. The Democrats will manipulate the advocates to the end of besting the Republicans.
• Illinois Democrats, like Dems at the national level, will continue to place corporate interests above the interests of the people. Ongoing support for Medicaid managed care is an example of this. They will continue to spout the false narratives created by the health insurance industry and promoters of profit-driven health care about the source of our health care problems and the solutions.
• This Protect Medicare coalition, in my estimation, has made a bargain with the devil, and it will come back to haunt all of us.
What was off the table at the summit and will remain so:
• Single-payer of course; therefore, evidence based health care policy, identification of administrative waste as the cause of our high health care costs, criticism of health insurance companies,
• Testimony about the harmful effects and other failures of Medicaid managed care,
• Holding Democrats responsible for not enacting a revenue solution when they had the power to do so,
> Criticism of the Democrats for the 2012 Medicaid cuts.
The place of the single-payer movement: Continue to speak the truth about the problems with our health care system, and about the only reform that is both morally right and evidence-based. Finding opportunities to do this may be difficult. We must do it nonetheless.
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[1] A brief bio of Olds Frey is included in this article.
[2] Fortino’s article is available here.
[3] Elizabeth Fowler was a VP of Marketing for Well Point Inc, now called Anthem, the largest for-profit managed health care company in the Blue Cross and Blue Shield Association. She left Well Point to become a staff member for the Senate Finance Committee headed by Senator Baucus (D-MT) and according to Baucus was largely responsible for crafting the Affordable Care Act (ACA). Following passage of the ACA, President Ob ama appointed her to Health and Human Services where she oversaw the implementation of the ACA. After that, she returned to the private sector by taking a senior-level position leading 'global health policy' at Johnson & Johnson's government affairs and policy group." For more on Fowler’s career, see here.
[4] My opinion piece about the wastefulness of redeterminations is available here.