Thursday, February 09, 2012

Federal Hlth & Human Services Allows States to 'Select' Coverage of Services, Thus Allowing Entities Like BCBSNC To Be In Control

"....One must ask whether it's a good use of resources to have 50 individual states analyze the relative merits of 10 different options for EHBs ..."

Or, one might ask what is the point of having various LME's in the state to manage Medicaid when I called 7, yes 7, times Friday a week ago trying to get an answer to a Western Highlands Network form which is online re: Provider privileges.....and have called the Director of Provider Relations three days in a row now, asking for a response which I submitted 9 days ago in order to request to request to be on the provider network for WHN so that I can be paid for my NC Medicaid work.

Yes, indeed, who profits by divying up all this administrative work? Not the providers; not the recipient of services. But rather the insurance companies and entities that act,look, and smell like insurance companies, such as the LME's in NC. Who profits when tort reform takes place such as was voted in by Republicans in TN, allowing physicians to form their own internal malpractice network? Not the citizens of the state.

Who is speaking---in a phrase----and as per French philosopher Michele Foucault's query: WHO IS SPEAKING------ when these kinds of actions take place?

In TN, it would be the insurance companies again...they are the ones that drive tort reform. And as re: NC mental health reform, it would be----again----entities that act or are insurance companies with all their inefficient management that creates barriers to care for both citizens--the insured---and the providers.

Follow the money.

The Value of Federalism in Defining Essential Health Benefits:

New England Journal of Medicine, February 8, 2012

"The promise of nearly universal health insurance coverage embodied in the Affordable Care Act (ACA) has meaning in part because it is tied to a minimum set of covered services called essential health benefits (EHBs). Health and Human Services Secretary Kathleen Sebelius surprised the health care community when, on December 16, 2011, she announced that there would not be one single national definition for EHBs.1 Rather, each state will have 10 options to choose from in defining the EHBs, 7 of which are tied to existing coverage in that state's small-group, state-employee, and health maintenance organization markets.

Although critics of this decision grudgingly acknowledge that it was good politics to avoid a high-profile national battle over benefit design, they generally see little substantive merit in the secretary's approach. Yet her decision is sound public policy and capitalizes on the strengths of American federalism that run throughout the new health care reform law

......Of course, federalism has some costs as well. The primary weakness of the secretary's approach is its potential inefficiency. One must ask whether it's a good use of resources to have 50 individual states analyze the relative merits of 10 different options for EHBs while also considering the very complex matter of the fiscal liability that those options will create for the state.5 And in the current political environment, giving states yet one more choice creates yet another opportunity for opponents of the law to delay its implementation....."


Post a Comment

<< Home