[mikemike]

They say the states are the laboratories of democracy and we will see how this works out. Starting next year, LA will be phasing out our publicly run medicaid plan in favor of a privately run program. In 2012, 850,000 current enrollees go private then in 2013 the remaining 350,000 go private and barring a repeal of expanded medicaid coverage by the ACA in 2014 500,000 more will be in the program.

It will be interesting to see if the $135 million/year in savings materialize and the private companies can do better than the publicly run plan.

Someone was asking whether or not the republicans had a plan for something to replace Obamacare and this is basically Jindalcare. It is what Jindal proposed in 1998 and he will have 5 years to prove its viability since he is going to easily win another term as governor considering that he is thus far unopposed and the election is in October.

By early next year, the planned privatization of the state Medicaid program will begin turning over $2 billion per year in tax dollars to private insurance companies to administer the care of 850,000 residents, mostly children. They form the first wave of the state's transformation of public health care that will eventually extend to the full 1.2 million clients in the program. That will grow by another half million or so in 2014 under the new federal health-care law, assuming it survives the courts and the Republicans.

With or without the new federal law, state privatization of Medicaid will go on, realizing the vision of a 24-year-old Bobby Jindal, who, as health care secretary in 1996, called for moving in that direction.

Under the new plan of Coordinated Care Networks, five insurance companies chosen by the state will form networks of doctors and hospitals to treat Medicaid patients under either of two managed-care payment models. When the plan is fully implemented, the administration projects $135 million in annual savings.

http://www.nola.com/opinions/index.ssf/2011/08/louisiana_legislature_left_out.html

[shooz]

YAY!!!!!!!
Free tax payer money to corporations!!!!!!!
To earn even more money...........There's a dead person over there and a sick one over there.

If he's so good at it. He should fund it with private corporate money.
But, he's not that good.
Can I get a refund on the taxes I paid in?

[GeneV]

I don't understand how this is really new. States have been turning Medicaid over to private insurance for long time. I remember representing doctors in the negotiations with our local private program, Salud!, ten years ago. The doctors got squeezed for the benefit of the insurer, and more doctors dropped out of the program. Between this and other insurance issues, my clients eventually folded up their independent practice and became employees of one of the plans. I don't know if it saved money, but it appears still to be in place. http://www.hsd.state.nm.us/mad/CSaludContactsPresbyterian.html

[shooz]

It didn't save money.
It just gave it to private corporations and investors.
Hows the profit margins doing?

[redrockcoulee]

In the Alberta experience in privatizing like mad in the 90s (but not health care) some things worked out better , some definetely worse and some things abandoned prior to it actually happening as it was determined that the private sector could not do some things (prisions for example) better than the government for the same amount of money.

It would be for more use to see if there is an actual savings in public money at the same time monitoring the health care provided for the same users. Not much point in saving money if people are sick or die. Or if the same out comes occur whether or not it is public or private. Will this be monitored with no political agenda?

On the other hand how is the US anything other than a private system with the government paying to the private sector most of the funds ?

[jeffkrol]

Under the new plan of Coordinated Care Networks, five insurance companies chosen by the state will form networks of doctors and hospitals to treat Medicaid patients under either of two managed-care payment models. When the plan is fully implemented, the administration projects $135 million in annual savings.

Sooo priv. companies CONTROL your health care or public..........

Priv. death panels are better than public right????

There will be no savings................I guaron-tee.......

So, with the administration calling all the shots so far, the largest public contract in state history will soon be let, marking arguably the biggest change ever in the delivery of government services, with almost no input from the Legislature. Privatization marches forward, and the babies will lead the way.

Smaller gov. my arse............

There are going to be problems with doctors and mothers complaining about companies disapproving procedures or mishandling claims. When their frustration levels peak, who are they going to call? Their legislators, of course. When those constituent complaints start coming in, the consolation for lawmakers is that they can honestly say they had nothing to do with it.

Tyranny.............

There is nothing to be proud of here..................

When the bill reached the floor, a large set of what were supposed to be cleanup, technical amendments were offered for one up-or-down vote. According to Senate minutes, McPherson complained that, on short notice, there was no way of knowing what was in the many pages of amendments. Senate Finance Committee Chairman Mike Michot, R-Lafayette, assured him all the changes were technical.

After the bill passed, McPherson discovered that in that stack of allegedly technical changes, his amendment requiring legislative approval had been deleted and one sentence was added, authorizing the administration to establish and write rules for "Coordinated Care Networks" for Medicaid.

McPherson doesn't know who made the switch then, and so says Michot. It just happened.

[shooz]

There will be no savings................I guaron-tee.....

There will however, be rising profit margins.
Therefore inflation.
Just what we need, more money fed to corporations that don't support anything but themselves.

Pinochet's Chile, here we come!!!!!!!!
The libertarian nightmare they refuse to admit.

[mikemike]

I don't know if it saved money, but it appears still to be in place.

I don't know if that is the same thing, from the page above the one you linked it sounds like it is administered by a government agency.

The Human Services Department's Medical Assistance Division (MAD) is the direct administrator of the New Mexico Medicaid program and Insure New Mexico! Solutions.

I did some looking and it seems like this is a trend that is happening here in Louisiana, Texas, and Georgia. It sounds like many states have already done some privatization and that Florida and California are planning to expand it. The Florida expansion is of course overshadowed by governor Rick Scott's business interests.

Here is an editorial in support of the plan by the dean of Tulane School of Medicine:

Recently a diabetic woman in south Louisiana gave birth to a severely premature infant weighing only 1 pound. The child has cerebral palsy and is blind.

A tragic, heartbreaking situation, this case also lays bare the deficiencies of the Medicaid system, which paid for the mother's prenatal care and also will be responsible for the long-term medical care of her child.

Because Medicaid emphasizes payment for the treatment of illnesses rather than their prevention, stories like this happen every day across our state and country. If the patient described above had private insurance, her diabetes would most likely have been monitored by a primary care physician and never allowed to reach a critical stage that would so adversely affect the health of her baby. Her baby would have been born healthy, thus averting both a human tragedy and an enormous cost to the taxpayer-funded Medicaid system.

This is why Louisiana Department of Health and Hospitals Secretary Bruce Greenstein, along with many providers and consumer advocates across our state, are proposing a major transformation of how the state operates Medicaid. Tulane University supports this goal.

Louisiana's plan to modernize Medicaid will move it into the mainstream of Medicaid programs in the United States. It will emphasize the value of care rather than reward the volume of care. Better management of patients and cost will encourage the development of medical homes and reduce the need for unnecessary services and hospitalization. It will turn Medicaid into a truly integrated system that provides our beneficiaries a choice in the coverage that best fits the health care needs of their families, better management of chronic diseases, improved health outcomes and rewards for quality over quantity.

The United Health Foundation's "America's Health Rankings" latest survey has again placed Louisiana at the bottom of overall health care outcomes nationally. We rank 45th for the prevalence of diabetes, 48th in overall cancer deaths and 48th for infant mortality.

Louisiana cannot remain at the bottom any longer. We cannot allow our people to languish in a broken system.

Today, more than 40 states have implemented similar initiatives to better manage the care their residents receive. We cannot make excuses for having higher rates of death from disease, poor access and high cost. Too many healthy lives are on the line. Too much is at stake for our state and its communities. The state's plan offers our best chance at helping people to get the appropriate and meaningful care they need.

Today, more than 1 million Louisianians are covered by Medicaid. After 2014, that number will leap to more than 1.8 million due to federal health care reform expansions. Without significant reform, we will enroll them into a Medicaid system that doesn't support the coordination of care that is the essential to the health of mothers, babies, fathers, brothers and sisters.

My wife is pregnant right now and has developed gestational diabetes, he is 100% dead on about the private insurance taking care of everything related to that and the doctor coordinating care. Our current system is 100% publicly administered now and it is obviously ineffective. The population of LA is 4.5 million so currently about 25% are on medicaid and soon that will shoot up to 40%. I think Jindal is as good as the republicans (or either party) has to a health policy wonk, he did his dissertation on it at oxford and has been working on the problems with the system for 15 years. Considering our starting point, if he can't make it work here it will be proof that this is not viable model for reform but likewise, if it succeeds in a demonstrable way it might show the rest of the country the way forward the next time we need to reform health care.

There will however, be rising profit margins.

There are two options under the reformed plan it sounds like under option 1, people are basically getting the best plan a large private company could get with the price per subscriber medicaid pays and with option 2 it is more like the traditional medicaid system crossed with an HMO.

The state will pay three networks – Louisiana Healthcare Connections, Inc., a subsidiary of Centene; Amerihealth Mercy of Louisiana, Inc.; and AmeriGROUP Louisiana, Inc. – a monthly fee for each of its Medicaid enrollees. The firm then is responsible for managing the care of its patients, approving services and paying the providers within the network. State Health Secretary Bruce Greenstein said the pre-paid network contracts will require at least 85 percent of the fee to be spent on medical care, a medical-loss ration that conforms to the regulations for large-group insurance plans affected by the 2010 federal health care law.

Two entities – UnitedHealth of Louisiana Inc., and Community Health Solutions of America, Inc. – will operate as “shared savings” networks. Under this model, the state will continue to pay providers on a per-service basis, but the networks would be responsible for coordinating a patient’s health treatment among primary care physicians, specialty physicians and other service providers. The network's profit would be a management fee that is a portion of what the state calculates is saved through a reduction in unnecessary diagnostic tests, hospitalizations or other treatment.

http://www.nola.com/health/index.ssf/2011/07/jindal_administration_announce.html

[GeneV]

I don't know if that is the same thing, from the page above the one you linked it sounds like it is administered by a government agency.

The government agency has the statutory responsibility, but every number and address on that page is for the Salud! contractor, PHS. They handle all the claims and the provider payments.