The managed care myth just won't die in Illinois. At a Young Republicans barbecue in Barrington last week, three Republican gubernatorial candidates
-- Sen. Bill Brady, DuPage County Board Chairman Bob Schillerstrom, and
Dan Proft -- all said if elected they'd establish a ...
The managed care myth just won't die in Illinois. At a Young Republicans barbecue in Barrington last week, three Republican gubernatorial candidates -- Sen. Bill Brady, DuPage County Board Chairman Bob Schillerstrom, and Dan Proft -- all said if elected they'd establish a managed care insurance system to help close the state's budget deficit. Managed care has become a central talking point on Sen. Kirk Dillard's campaign as well. “Every other state has managed care for Medicaid," he said a few weeks ago at the Macomb Country Club, "and we ought to have it here in Illinois too.”
But as we've pointed out repeatedly, Illinois already has a voluntary private managed care system and a successful publicly-managed care program. The latter provides coverage to over 400,000 Illinoisans and has already shown impressive cost-saving capabilities. And once it's fully implemented, it will house the vast majority of the state's Medicaid and SCHIP populations.
What Republicans are talking about is forcing the state's public health recipients into a private, HMO-style managed care system. On his blog this week, Sergeant Shriver National Center on Poverty Law President John Bouman issues a comprehensive reminder about the danger of such a plan:
Adding to the concerns evident from the model itself, there have been misadventures around the country. California experimented with requiring its Medicaid population to move to capitated managed care in an effort to control costs. In the end, it was found that despite a dramatic increase in Medicaid capitated managed care enrollment there was neither a significant reduction in spending nor improved health outcomes, and a study concluded that this policy actually, "reduced the efficiency of the Medicaid program in California ... In fact, Medicaid spending appeared to increase by almost 20 percent following the shift to managed care and persisted long after the mandates first took effect."
Nor can Illinois ignore its own recent history: The Illinois case of Memisovski v. Maram revealed that well child care at Medicaid HMOs in Cook County was well below that provided in fee for service, and it revealed that the HMOs could not account for the amount of care being provided. Further, Amerigroup, one of the managed care organizations with which Illinois once contracted, defrauded Medicaid by enrolling recipients in a discriminatory way, systematically avoiding pregnant women and people with disabilities. This history places a burden of proof on the proponents of capitated managed care to show that it will not endanger patients in a failed attempt to save money. The baldly political invocation of the capitated managed care idea in the current state budget debates does not meet this burden - it doesn't even try.
Perhaps the state can devise and implement an integrated, well-coordinated capitated managed care program that resolves these concerns. The Quinn Administration is planning a pilot program, and we hope it is done with this kind of care. But if it is meant magically to produce $1 billion dollars in quick savings, then it will fail. The only way to get a billion dollars, if you're not just cutting care, is to reform the whole healthcare system. They're doing that in Washington.
Read the whole thing here.