Medicaid HMOs: Dump 'Em

Every wonder how Medicaid HMO's like WellCare, Centene Corporation, Molina Healthcare and Amerigroup Corporation can make so much money? Me too. But their profits have been so impressive that they're "giving back" to their communities and to politicians, even when most of their clients can't afford health care. From this morning's Wall Street Journal:

Centene last year was the biggest donor for a $9.5 million renovation of an arts building in St. Louis, now called the Centene Center for Arts and Education, according to a spokeswoman for the center. The company paid $200,000 last year for the naming rights of a minor-league baseball stadium in Montana, where Centene employs 100 claims processors but doesn't have Medicaid clients. Centene also pledged $400,000 this year to the school district in Clayton, Mo., where the company has its headquarters, to rename the district's stadium.

Could it possibly be because they are not health care insurance providers but health care insurance deniers? After all, Medicaid HMOs, like other HMOs, seek to save money by eliminating unnecessary care and paying for preventive treatments. But who is deciding what amounts to "unnecessary care?"

Kuldeep Singh, an internist in Valdosta, Ga., says that when Georgia began to move more than a million Medicaid recipients into HMOs this year, he suddenly faced hurdles not imposed by regular Medicaid. Recently, he says, one of his assistants had to wait on hold to get approval from WellCare for a hospital chest X-ray on a patient suspected of having pneumonia. "It was ridiculous," says Dr. Singh. A spokesman for WellCare says it sometimes requires such approval because hospital-based X-rays cost two to three times as much as those done in a doctor's office or imaging center.

Oh, I get it, take a sick, coughing person from a hospital to a doc-in-the-box. Brilliant, just brilliant. At least our state has caught on:

In Illinois, the state and the Justice Department asserted in a lawsuit that Amerigroup spent only $131 million on medical care from 2000 to 2004 despite taking in $243 million from the state. The lawsuit accused Amerigroup of fraudulently trying to exclude pregnant and sick patients to reduce its medical costs. A jury in Illinois state court agreed last month, finding Amerigroup liable to the government for $144 million. Internal Amerigroup emails filed in court show managers contemplated disciplinary action for employees who signed up women in the third trimester.

It doesn't take a rocket scientist to figure out these guys are bilking our health care system. It's time to dump 'em.

Maybe then they'll get the message: patients come first, before communities and before politicians.

-Wes