By Adam Searing, NC Health Access Coalition
When you bring your late-model car into the dealership for an oil change and they call you saying you need a $600 valve job and “radiator flush,” that would make all but the most gullible of people a little suspicious. Fixing something that isn’t broken in order to pump profits is a favorite tactic of unscrupulous businesspeople and, unfortunately, is sometimes the name of the game in delivering health care for low income people.
Amerigroup Corporation, a company facing hundreds of millions of dollars in fines and a history of discriminating against lower-income pregnant women, is poised to make just such a jump to help “fix” North Carolina’s Medicaid program.
Medicaid in North Carolina provides health care to our lowest-income and most vulnerable citizens. Lower-income children make up the bulk of folks covered by Medicaid with some parents, people with serious disabilities, and very low income elderly citizens also qualifying for coverage. In North Carolina, Medicaid often is more efficient and even delivers higher-quality care than the private sector for many kids and high-risk patients.
One way NC Medicaid is doing this is through “Community Care.” North Carolina’s Community Care effort is so innovative in saving money and delivering both excellent preventive and major medical care that it’s a finalist for one of the most prestigious health policy awards in the country from Harvard University this year. Illinois is even using the program as a model for its own effort to cover all children in the state with health insurance.
Community Care identifies patients at high risk of overusing the emergency room, not getting the preventive care they need, or with other health problems and helps get them the services they need. Sometimes it’s as simple as getting an isolated elderly patient with diabetes a regular ride to their family doctor so that thousands are saved in unnecessary hospital admissions. In 2005 and 2006 a study by the private Mercer government consulting firm found Medicaid’s Community Care program had saved state taxpayers $124 million. Estimates this year show similar savings of over $200 million.
Community Care doesn’t operate in a vacuum. NC Medicaid pays primary care and family doctors enough for their services that such practices overwhelmingly are willing to see people on Medicaid. Combine this access with Community Care’s focus on prevention and high-quality care and you get satisfied patients, excellent health care and lower costs.
Amazing success, innovative government, efficiency and quality care. Community Care is a true government success story. Unfortunately, this very success has attracted the health care vultures into North Carolina. For-profit companies are eager to create their own version of the model and make millions for their executives and stockholders in the process.
The primary force behind this effort in North Carolina is the for-profit Amerigroup Corporation. This company promises to do for North Carolina what Community Care is already doing. Of course, any savings must go to pay stockholders and to pump up profits rather than staying in the state for other needs. Amerigroup has done all the right things. They hired a prestigious local lobbyist, contacted leaders in the state Senate and helped get a bill introduced, (S1042), that would force Amerigroup-style for-profit HMOs for vulnerable Medicaid patients in four areas of the state.
If this weren’t bad enough, Amerigroup has just been hit with a $334 million judgment in a case brought by the Illinois Attorney General and the United States Justice Department. Amerigroup, in an attempt to pump up profits, made a practice of trying not to sign up pregnant women, especially later in their pregnancies. Keeping these women out ("Please keep up the good work with the marketing reps of not trying to sign up pregnant women" read one email to Amerigroup managers) has inflated cost savings and resulted in millions more in illicit profits for Amerigroup.
Amerigroup tempts legislators with the siren song of lower Medicaid costs without having to take a political hit for denying health coverage or services to our frail elderly and children. Instead, Amerigroup or another for-profit HMO takes over North Carolina’s Medicaid program and starts to quietly deny coverage as they did in Illinois. There’s a more insidious way these companies are likely to deny care as well. They’ll be free to ratchet down payments to doctors – one of the only other ways to save major health dollars in Medicaid. As doctors leave the program because they can no longer cover their basic costs of seeing Medicaid patients, presto – less care for people on Medicaid, more “savings” and more profits.
For-profit HMOs like Amerigroup have no place in North Carolina’s innovative Medicaid program. In our state, doctors, hospitals, government managers and families all work together to lower costs and provide the best possible care for the most vulnerable. North Carolina should stay with success and resist ill-advised calls for such privatization.
Adam Searing is the Project Director for the North Carolina Health Access Coalition
