Expert: Obamacare to Herd Disabled Seniors to Bare-Bones Medicaid Plans

Friday, 27 Apr 2012 11:13 AM

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Dr. Scott Gottlieb, a former senior official at the Centers for Medicare and Medicaid Services in the Bush administration, warns that under Obamacare disabled seniors who are eligible for both Medicare and Medicaid will receive inferior care, according to a report by the New York Post.

Gottlieb, an American Enterprise Institute resident fellow, says these low-income people who are elderly or have disabilities will be uprooted from the tried-and-true Medicare fold and “herded” into state-run Medicaid plans as another phase of Obamacare grips the nation.

“It’s hard to see how they’ll be better off in bare-bones, and sometimes poorly-run state Medicaid plans than by getting access to Medicare options they were entitled to before Obamacare,” Dr. Gottlieb lamented on Friday.

A so-called Obamacare “demonstration” program kicking-off in January will turn over management of such “dual-eligibles,” along with the money that the federal government was spending on their medical care to any state that wants to climb aboard the latest federal money wagon.

Some cash-strapped states are jumping at the chance to capture federal Medicare dollars for their Medicaid programs, according to Gottlieb.

Indeed, some anxious states have already committed to automatically placing these folks in existing Medicaid plans. Big problem lurking here, says Gottlieb: Such plans often aren’t equipped to serve an older, sicker group of patients. “That will mean big savings for the state and worse care for the vulnerable,” he concludes.

The doctor cites significant examples:
  • New York is looking to shift 700,000 “dual-eligibles” into a capitated managed-care model or HMO-style care. The target: Corral most of the elderly poor and disabled by 2015.
  •  California plans to move up to 1.1 million duals into its state-run Medicaid managed-care system.
These examples are but the tip of a huge green iceberg of big cash.
According to the Post report, Wall Street figures the entire “dual eligible” market at $350 billion a year.

While this is good news on The Street where the stocks of Medicaid HMOs are being bid skyward, Gottlieb is not consoled. “Care is likely to suffer. Many of these elderly poor also suffer from a lot of chronic ailments like diabetes and lung disease. [T]hese people have diverse medical problems, and have been most successfully served by Medicare programs that tailored services to their specific needs.”

Gottlieb’s bottom line: The Obamacare demonstration looks like an effort to shore up Medicaid by subsidizing it with Medicare dollars. “It’s another case of how Obamacare is designed to serve the existing health-care system, rather than transforming it to meet the needs of individual patients.”

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