The biggest mistake that consumers can make, in my opinion, is to drop the ball in weighing the impact of healthcare reform on their lives, thereby leaving managing such reform to the other stakeholders, politicians, health insurers and healthcare providers whose motivation is profit with the secondary goal of treating patients, versus consumers whose goal is maintaining and achieving health.
Consumers must relentlessly protect their own goals through electing officials who mirror their viewpoints, communicating with state insurance departments when there are issues with that experience and staying on top of proposed changes that risk their care.
Our goals, affordable health CARE (which is different from health insurance), that is accessible and that maintains quality that makes that healthcare effective, remain under attack. These goals are vulnerable to healthcare reform’s current UNWILLINGNESS and INABILITY to address the EXPENSES within the healthcare industry that are outside the control of consumers, the excessive expense increase in costs of services AND the excessive cost of FRAUD within the healthcare industry.
Instead, ACA and other healthcare reform revolves around pinching, managing and controlling the consumer, often to the detriment to the service, care, cost and accessibility of obtaining needed medical care.
This week, group homes in NC are making front-page news in that state with headlines like, “Medicaid Clock Ticking on NC Group Home Residents,” (wral.com 12/11/12), and “Alzheimer’s Patients Caught Up in State Medicaid Service Changes,” North Carolina Health News 12/14/12.
In an effort to support evenness of treatment, Federal Medicaid rules require that fees for personal services such as bathing or feeding should be reimbursed at the same levels for those living in group homes as for those remaining in their own homes. The policy was designed to support individuals in remaining in their own homes.
In NC, without much fanfare, in the spring, the monthly hours of personal care services available were cut from 120 to 80 and requirements that personal care assistance be provided in a more concrete form than simply supervising and encouraging the patient to perform the task, actually helping or performing the task for the patients, were put in place. Both cost-saving provisions enacted in NC to comply with the Federal rules.
Now some group-home residents face being forced from the group homes.
The above problem, with a public insurance program will ultimately have to be solved with a state solution, the state of NC will have to determine whether it can provide the additional funds necessary for group homes to stay opened since the Federal government has communicated that there is no Federal solution to the problem.
For those of us who are privately insured, take notice. Obamacare is committed to increasing “cost sharing,” having individuals pick up the slack of expensive healthcare services so that insurance companies can cover essential health benefits and preserve their profits and so that medical services providers can continue to charge the exorbitant prices for needed medical care charged today.
Consumers need expense caps, cost controls, limits on how much can be charged for needed medical care instead of the current “whatever the market will bear” approach that promises to collapse every system of health insurance, not only the public system of insurance. Consumers also need to demand that fraud prevention be given a priority reflected in processes that are consistently engaged and are carried out in an ongoing fashion to prevent and track down fraud.
