Quietly, over the past six years, an experiment in providing healthcare for the poor has been playing out in Broward and four other counties around the state. Its basic goal is to relieve the financial pressures of Medicaid on Floridas taxpayers by turning over poor and disabled patients to private companies, a move lawmakers believe will cut costs.
Conservatives love the Medicaid reform program, pointing to an in-depth University of Florida study indicating that the experiment has lowered costs while not raising consumer complaints. The Legislature has already approved a slightly modified model of the reform to go statewide. At least one national think tank believes it should be a model for the entire country.
Liberals decry the effort as a way to build corporate profits at the expense of the poor. Howard Mallinger, a Sunrise retiree, thinks theyre right. He has two adult sons with mental health problems who are in a Medicaid health maintenance organization. The HMO frequently wont provide their medications, or is slow to approve them, causing their health issues to spiral out of control, Mallinger says.
One son has been involuntarily committed under Floridas Baker Act 44 times in the past five years, he says. That often means expensive three-day hospital confinements. The joke is on the taxpayer, Mallinger says.
With state taxpayers spending $21 billion a year on Medicaid and 3.2 million Floridians depending on it for their care, including 270,000 in Broward, the stakes are huge. The UF research shows the pilot has saved the state about $100 million a year, and Floridas leaders are determined to take the HMO-style reform statewide as early as 2014.
But three serious problems with the pilot could threaten the plans statewide success:
• R. Paul Duncan, the professor who led the much-discussed UF study, says he has yet to answer one crucial question: Does the new system cost less because insurers are providing more efficient care or are they simply giving patients less care?
That is a very big deal, he says.
Though discussion of the pilot focuses almost entirely on for-profit HMOs, two of the biggest and most successful groups in the program are nonprofit provider service networks (PSNs) paid on the traditional fee-for-service basis that the state is trying to abolish.
• Many hospitals love the pilot, saying theyre satisfied with the payments they receive. But many doctors hate it, citing complaints from their patients and their own low reimbursement rates. The conservative Florida Medical Association, which represents the states doctors, adamantly opposes the statewide expansion.
• The presidential election is likely to play a role as well, since the federal government provides more than half the funding for Medicaid. The Republican platform favors letting states do what they want with Medicaid, while the Obama administration is likely to demand major changes before allowing the pilot to go statewide.
In the last 12 years, Floridas Medicaid program has grown five times faster than general revenue. It now consumes 30 percent of the states budget and keeps growing.
Medicaid has commandeered the state budget and crowds out our ability to fund other worthwhile priorities, such as our colleges and universities, public safety and transportation, complains Sen. Joe Negron, R-Palm City.