Medicaid for the Poor, If They Can Get It

Health Care

            New Orleans      It’s a simple fact of the modern economy and our peculiar economic system, that when you turn over the management of a public program to a private entity, whether it be housing, health care, welfare, or pretty much whatever, and the direct or presumed incentive for the private enterprise, will not be to facilitate access by recipients, but to deny them, then they will.  How else can the private outfit justify their profit off the public purse?  This is painfully true when access is discretionary, allowing more bias and expectations of reward to drive down participation, but it is especially the case in dealing with the few overall entitlements left in the American benefit system.  I would almost call this Wade’s Privatization Law, except that at this point in the neoliberalism nightmare we’re all hoping to survive, this must be obvious to just about everyone, even if they are unwilling to admit it.

More evidence of the inevitable results of such private corruption of public entitlements comes now in a report from the inspector general’s office of the US Department of Health and Human Services.  They found that a number of the huge private insurance companies that contract to manage the health care of millions upon millions of lower income families under the Medicaid program have absurdly high denial rates that also prevent millions of poorer families from receiving health care.  As reported in the Times,

The for-profit insurance companies, including Aetna, Elevance Health, Molina Healthcare and UnitedHealthcare, operated some Medicaid plans that denied medical care under requests for prior authorization of services by rates that were greater than 25 percent in 2019, the report found. About 2.7 million people were enrolled in these plans at the time. Another 8.4 million were enrolled in plans with above-average denial rates from 15 to 25 percent.

Don’t get me wrong.  We’ve done a bunch of reports on nonprofit and other hospitals and how they’ve handled charity, so I’m not saying that doctors and hospitals are always heroes here and not doing their own share of money-grubbing.  The IG’s report is calling for state and federal officials to up their oversight game, as well as calling for a revision of the incentives for the private profiteers to reject medical care for the poor.  Unfortunately, states have some financial incentive to reject people, not only because of the small share of their financial participation, but there are also a number of states now that have an ideological and political program based on punishing the poor and denying benefits.

The same practice by private insurers is also the case in Medicare Advantage for seniors, but there they reject care for fewer oldies than the poor.  Small comfort, that is.  Same problem, different verse.  Denials were 12% of requests in 2019, but “Unlike with Medicare, if an insurer refuses to authorize a treatment, patients are not automatically provided with an outside medical opinion as part of their appeal.  They are entitled to a state hearing.”  Just picture these sick geezers putting all of those pieces together, if you will?  Mostly, not happening.

This is all just so wrong.  While the companies are pocketing their share, families needing health care can stay sick or die.