In our view: Health Care Turmoil

About 47,000 Medicaid patients in Clark County are about to be thrust into turmoil — as will the health care plan that has served them for 18 years — if the state Health Care Authority has its way. The HCA has selected five health insurance plans that appear to have successfully bid to provide Medicaid services, and Columbia United Providers, a Vancouver-based nonprofit, is not among the five that were chosen.CUP is owed a full explanation for several reasons, chief among them being these two:

First, many of those 47,000 residents who depend on CUP (and who, as low-income residents, have no high-powered lobbies working on their behalf) could be forced to find new doctors (no easy task in the Medicaid world). Their already limited access to health care could be jeopardized. That’s troubling not only for them, but for taxpayers who expect efficient use of public money directed to Medicaid.

Second, CUP is a community-based plan with low overhead, no profit motive and no inherent function to enrich corporate shareholders in distant places. It serves 89 percent of the county’s Medicaid Managed Care population. By contrast, the five plans apparently selected by HCA include two Fortune 500 companies, a subsidiary of a Fortune 500 company, a for-profit California company and a statewide nonprofit group based in Seattle. For the first four, profit reigns supreme among priorities.

Because negotiations are still under way, HCA officials are not offering public comment on these intricate changes in the increasingly tumultuous world of health care and Medicaid. But the fact that the contracts, which start July 1, would extend for only a year and a half demonstrates the uncertainty of health care and health insurance nationwide.

All the more reason to keep a reliable and proven success like CUP in place.

HCA is correctly driven by the desire to reduce costs. We admire that goal in a state agency. But CUP officials say they’ve already cut costs by about 4 percent. Also, they’re understandably reluctant to further reduce reimbursements to doctors who already are tempted to drop Medicaid patients.

From the sidelines of the HCA vs. CUP issue, local public health officials are encouraging an appeal of the recent decision. A policy briefing signed by four public health officials in Clark County presents five questions for which CUP is owed answers. We agree with the expressed urgency to answer these questions, as part of the appeal process and to keep the public informed:

• What were the scores for those who bid for the Medicaid plan contracts?

o Why was CUP not selected? What were CUP’s assessed strengths and weaknesses?n Given that CUP has negotiated rates acceptable to providers, how can HCA guarantee that new health plans will recruit the necessary health care providers, and for lower reimbursement rates?

o What would HCA do if assigned health care plans don’t sign up enough providers?

o How will HCA assure a smooth transition for these 47,000 patients in Clark County (and around the state) to new plans and often to new providers?

For now, and until those questions are answered, we see no reason to create upheaval in a public health care system that’s already immersed in uncertainty. That confusion and doubt is widespread currently, and even more so long-term. CUP officials worry that the system could be made much worse. Because of their long and distinguished track record, they deserve to be told otherwise by the state agency.