As overall federal healthcare funding gets leaner with the proposed Senate Better Care Reconciliation Act of 2017 — a healthcare bill that rolls back taxes and slices through the corset of the Affordable Care Act — deep cuts to Medicaid are making the most headlines.
Medicaid is poised to get meaner. The New York Times is filled with editorials, such as a recent one about leaving states to make difficult choices in how they will provide for the disabled, elderly and health-afflicted that rely on Medicaid.
A recent case in point foreshadows how cuts will fall on people relying on Medicaid, and their caregivers.
Cut to the Colostomy Bag
NH Healthy Families, underwritten by Granite State Health Plan, Inc., and owned by Missouri-based Centene, recently informed its insureds that it will no longer pay for colostomy pouches, which cost between $135- $200 per box.
Under Medicare Part B, ostomy supplies are typically covered. But under a state Medicaid Managed Care plan, the company seems to be relisting the pouches as non-essential durable medical equipment.
One anonymous caregiver was very concerned about the benefit loss. “How often do you go to the bathroom every month? These people have no income source. They are totally disabled.”
Medicaid covers long-term care for millions of people, not just the elderly, and its essential to 90 million family caregivers, according to Forbes.
While the Senate bill may promote states’ flexibility in healthcare spending, the loss of more than $800 billion to Medicaid over the next decade would likely remove people from the program, cut services, reduce payments to providers and drastically increase out-of-pocket costs to caregivers.
The collateral damage could prove to be catastrophic to families. The out-of-pocket costs for medical equipment like ostomy products could be $10,000 per year, according to John Schall, CEO of the nonprofit Caregiver Action Network.
Cost Control is a Double-Edged Sword
While insurers are exiting many of the exchange marketplaces leaving numerous counties with little to no affordable healthcare plans, Centene Corp. doesn’t plan on slowing down.
According to a Modern Healthcare report, the company’s revenues continue to grow. In 2016, its revenues increased through expansion of its Medicaid coverage. Centene will start offering coverage on exchanges in Kansas, Missouri and Nevada, in addition to expanding its presence in six states.
Centene’s analysts are able to cut government health costs, and as a result the company has grown and diversified. According to a 2012 article in the St. Louis Post-Dispatch, “This country doesn’t have endless dollars. Our job is to provide higher quality care at the lowest possible price,” said Michael Neirdorf, the company’s chairman, president and chief executive officer. “We go to states and ask to take on their sickest populations.”
While its data, known as Centelligence, predicts patient risks factors and the company’s health plans offer numerous wellness programs to help prevent high predictable medical costs in the future, Centene also looks where it can cut health care costs for states now.