Suzy Khimm is fast becoming one of my must-read journalists covering health care policy. She seems to understand the nuances of the budget debates over entitlement programs better than many of her peers. Her coverage of Medicaid issues is particularly good, as evidenced in this guest post at Ezra Klein’s blog on Medicaid and managed care. Khimm notes that more states are requiring people with disabilities and the elderly to enroll in managed care as a condition of receiving Medicaid. States hope that a managed-care-for-all model will help control Medicaid costs at a time when nearly every state is facing enormous deficits. The evidence for managed care as a cost containment strategy is dubious at best, but that hasn’t swayed states like Florida from passing sweeping legislation that will transform its entire Medicaid program into a managed care model.
Here in Minnesota, Governor Dayton recently vetoed a human services bill that would have placed people with disabilities and the elderly in Medicaid managed care and similar legislation might be put forward again in a special session. I remain unconvinced that managed care organizations can deliver lower-cost care to a population that is inherently expensive. State legislators’ enthusiasm for the model can mostly be ascribed to two things: a belief that the private sector does everything better and sheer fiscal desperation. And since managed care has not been previously used for these populations, legislators are free to book savings that are mostly conjecture and guesstimates. What remains to be seen is whether these same legislators will still be as enthusiastic boosters of private enterprise when the managed care organizations start demanding more money to serve people like me.
