Comments on: South Carolina’s View: The Affordable Care Act’s Medicaid Expansion Is The Wrong Approach

By: Mental Health Update: Expanding Services, But Limiting Access : HEALTH REFORM WATCH

Thu, 07 Feb 2013 03:49:11 +0000

[...] Medicaid, or participate in any health exchanges’” (emphasis in original). According to the Health Affairs Blog, South Carolina’s refusal to expand its Medicaid program would prevent more than 500,000 South [...]

By: MPATE

MPATE — Wed, 03 Oct 2012 14:34:32 +0000

Mr. Keck’s statement that “..the state (South Carolina) has one of the highest rates of physician participation, largely tied to its high Medicaid reimbursement rates” is true only if you are not an anesthesiologist. Because South Carolina uses Medicare rates as its benchmark for setting Medicaid rates, the result is a grossly out of parity rate system that greatly undervalues anesthesia services relative to ALL other medical and surgical specialties. The Medicare rate for anesthesia services in South Carolina is the lowest in the South and in the bottom 2% of all Medicare CFs in the United States. As compared to commercial rates, Medicare pays physicians between 76-83% of their commercial rates, except anesthesiologists who receive 26-28% of commercial rates. Add to that the fact that S.C. Medicaid pays only 82% of the Medicare rate, and one can quickly see the parity issue is magnified. Policy makers don’t want to hear about the anesthesia issue because it would cost money to fix and with an already strained financial environment, it’s easier to ignore and hope no one notices. Well, anesthesiologists notice and will challenge universal statements about Medicare and Medicaid reimbursement rates that refer to ALL physicians.

By: Adaeze Ude

Adaeze Ude — Mon, 17 Sep 2012 16:58:07 +0000

The view not to accept Medicaid expansion is a very confusing one as to base it on an expansion that would hurt the poor. The rule of life which leaves one healthy and employed one day and sick, injured and at the mercy of Medicaid the other is one that we all in this country need to have in mind when advocating for health coverage for all. I agree with you and Robert that reducing unnecessary services and the unit cost of these health services should be addressed. The high cost of per health service cost had lead to a band of fraudulent practitioners and business personnel who had billed the Medicaid and Medicare enormous amounts for services never provided by using names of deceased or Medicaid patients who visited their clinic at one time or another. If there is a competitive market, patients who pay out of pocket for insurance as well as Medicaid patients with co-pays will end up using such cost effective services. Although growth in health care sector employment should not be an excuse or reason for reform, it does not divert money that would create other jobs. Job loss is a global issue due to economic crisis and political ambitious strategies and has nothing to do with health care allocated funds to improve and create health care jobs. We should not mix the fact that most corporate firms are shifting competitive jobs or manufacturing of goods and services to oversea and then bring them in here to sell as the result of health care spending. Like Robert suggested a competitive market where providers bid to gain access to providing services stands a better means of cost effectiveness that will eventually affect the per person cost in the long run.

By: James Rickert

James Rickert — Thu, 06 Sep 2012 21:55:33 +0000

While I applaud South Carolina’s efforts to improve their health care system and the efficiency of care delivered there, your argument falls apart because of this quote from your last paragraph: ” uninsured individuals who need care should be able to receive it.” Yes, they should be able to do so, but they are generally completely unable to receive quality care. How do you propose that they receive this care?
You mention that doctors are more likely to accept Medicaid patients when Medicaid reimburses more generously; by the same logic, doctors are most unlikely to accept patients when they receive no reimbursement at all. You quote the Institute of Medicine selectively. They also reported that 137,000 people died from 2000 through 2006 because they lacked health insurance. South Carolina has its share of these people.
You mention Oregon’s experience. Among other findings, women with Medicaid insurance were 60 percent more likely to have mammograms, and those with insurance were 20 percent more likely to have their cholesterol checked. They were 70 percent more likely to have a particular clinic or office for medical care and 55 percent more likely to have a doctor whom they usually saw. This did increase costs because suffering patients could finally access the system, but the health benefits to Oregon’s citizens are undeniable.
Our health care system is a mess. We need to improve it. South Carolina’s experience should contribute to this improvement. However, if South Carolina’s Administration feels that the benefits of health insurance are not worth the cost, why do the Governor and the rest of her administrators bear the costs of their own insurance?

By: RobertBurney

RobertBurney — Thu, 06 Sep 2012 20:27:03 +0000

As a country, we must provide access to healthcare for all our citizens. At the same time, we must bend the curve and reduce our expenditures for healthcare. The proposed approach here stops one level short of an effective solution. It is not per-person expenses but per unit of healthcare services that should be attacked. And we do that thru price competition. Healthcare is so inefficient because there is no incentive to improve. If providers/institutions had to compete on price for business, they would become more efficient and prices would come down. Medicaid should publish an RFP for their most common procedures/services. Low bidders get the contract. This works in other industries, and it has worked with Medicare durable goods contracts. It could work with total hip replacement and other healthcare services.