I featured a different approach to caring for the poor two posts ago. That approach is in full gear with the Healthy Indiana Plan 2.0, which I described in that former post. The HIP 2.0 plan is using the basic approach touted by many free market advocates in providing a monetary account of $2,500 (that would imitate a market Health Savings Account) to each beneficiary and a High Deductible Health Plan, which is an “insurance plan” to cover medical expenses if the monetary account is exhausted.
When I read articles about different issues in health care, I generally make a point of reading people’s comments about the article to see how those ideas are being received. I did that in the case of the article entitled “Healthy Indiana 2.0 is Challenging Medicaid Norms” by Seema Verma and Brian Neale in Health Affairs Blog, which is the article I based my post on.
Sometimes the comments I read are supportive, sometimes they raise questions about the topic, and sometimes they are clearly just meant to tear down an idea with or without reason.
I am going to take a few of those questions or criticisms I found in the comments section and analyze or answer them.
What About the Most Vulnerable People?
One doctor asked what protections are in place for the most vulnerable people in Indiana – the disabled, the blind and the aged?
I agree that the article was geared toward what is being done to assist in making sure able-bodied but low-income Indiana residents have a way to tend to their health care needs, and did not address the more needy people. I wanted to answer this question in my mind as well, so I called the Medicaid service line for HIP and spoke to a representative who told me that the disabled, blind and elderly people who are not covered by Medicare are taken care of by Hoosier Care Connect, which is a group of managed care plans from which these Medicaid beneficiaries can choose.
There is also a program that provides assistance to disabled people who are employed, ensuring that they have access to Medicaid coverage and are not penalized for working additional hours, or even getting a raise. Even though I am not a big fan of too much government intervention, I do feel that it is probably appropriate to protect disabled employed people who, I am sure, have more than the average challenges in life and could be at risk of “falling through the cracks.”
So that answers the question regarding the provision of care for vulnerable “populations.” However, I hate to use the term “population” in connection with people and health care because everyone is an individual with their own needs, issues and challenges.
Encouraging Health Care Consumerism Among the Poor
Someone else who commented brought up the issue that HIP 2.0 beneficiaries are informed, through a monthly statement, about the cost of medical care they received with the intention of teaching them to be better health care consumers. Her contention was that the effort to encourage beneficiaries to be better health care consumers was toothless unless they could find out costs before receiving care.
I have two responses to this issue.
*First of all, maybe if HIP beneficiaries look at a bill detailing how they have spent their health care dollars, they could make a learning experience out of trying to find less expensive (but still high quality) care elsewhere. The comment that most people find it very difficult to find out costs for care ahead of time can be true, although this is most often true of hospitals.
With the use of their $2,500 monetary account, these beneficiaries might seek out a physician who does Direct Primary Care. Although Direct Primary Care physicians generally operate “third-party free” which means they do not take Medicare, Medicaid or even commercial insurance, it seems that if the Medicaid beneficiary is using their POWER account to pay for their care directly, the DPC option could work well for them, and even prolong the availability of those funds during the year.
*The other issue, in terms of most people finding it difficult to find out costs for care ahead of time, is something that needs to change throughout the country. It’s high time that we all started demanding transparent pricing. If surgical facilities such as Cedar Orthopaedic Surgery Center in Cedar City, Utah or Surgery Center of Oklahoma in Oklahoma City, along with many other surgery centers and Direct Primary Care physicians that are riding this wave, can do this, hospitals will eventually find that they must do this too if they expect to keep getting patients for elective procedures.
Out With the Old…In With the New!
Yes, every new, out-of-the-box concept may have its wrinkles, questions to answer, and improvements to be made, but it’s time to veer away from the same old way of providing charity care that seems to only dig a deeper and deeper hole in government spending with questionable results.
If you are interested in delving deeper and reading the article I referred to, here is the link. Feel free to let me know what you think about this by commenting on my blog. Also, look for my email subscription service at the upper right hand corner of this post so I can update you on new posts in my blog and future offers.