As Medicaid privatization moves through House, Broward County brings concerns
A House panel cleared its version of a Medicaid overhaul Thursday. While many of the details are quite different from the plan being discussed in the Senate, the basic principle is the same: It would shift most patients into HMOs and other managed-care organizations.
Supporters say the measure would make the cost of the program predictable, while also improving patients’ access to care.
Broward County Commissioner Barabara Sharief told the panel that the experience of her county, which is part of a Medicaid managed-care pilot program, highlights problems with the managed-care model.
“Many patients complain of not having access to specialty physicians and losing access to care,” she wrote in a letter to lawmakers.
The problem, she said to the panel, is that it’s hard to profit from caring for patients without limiting access to services.
“The thing that’s driving all this is money,” said Mark Pafford, the ranking Democrat on the panel, adding: “We’re not really taking things into consideration that would improve quality and access.”
Michael Garner of the Florida Association of Health Plans has testified that managed-care plans have an incentive to keep an eye on costs in a way that the existing fee-for-service system does not. They use more generic drugs, for example, and focus on maintaining patients’ health to prevent costly conditions from occuring.
Sharief said the Broward experiment has been especially difficult for patients who are already chronically ill. The managed-care model may prove capable of improving limiting costs without compromising quality for patients who are currently healthy, but what about the sickest patients who require the most care?