My state is trying to make hospitals take Medicare rate X 1.75 for our state employees

[dsc]

This discussion thread was locked as off-topic by DonViejo (a host of the Democratic Primaries forum).

and the hospitals are saying hell no.

https://www.thetimesnews.com/news/20190716/state-health-plan-may-cost-teachers-thousands?fbclid=IwAR2_SC2M9D_Yjbefo6t5ToHWQm6yUtNUAHASwWEQdVC4gDgWyHhX5jyK0aE

Last October, State Treasurer Dale Folwell decided to cut reimbursement rates for healthcare providers accepting the State Health Plan by tying them to Medicare reimbursement rates. According to the Winston-Salem Journal, the state treasurer has the authority to do this.

At the Board of Education work session Monday, July 15, ABSS Chief Finance Officer Jeremy Teetor told board members Cone Health has decided its hospitals — including Alamance Regional Medical Center — will treat the SHP as “out of network” if these changes go into effect Jan. 1.

“We’ve got some major healthcare providers in North Carolina that are declining to participate because they would lose money,” Teetor explained. “In the Winston-Salem Journal, Cone Health [said] they would lose $26 million in revenue because of [the reimbursement rates]. The UNC System is declining to participate. Wake Forest Baptist Medical is declining to participate, so we’ve got some very major providers in our area here [that are declining it]. And this would have a very big impact for Guilford County Schools as well.”

In April, the N.C. House passed a bipartisan bill to delay the change for one year, giving healthcare providers time to reach a compromise with Folwell. The Senate has yet to acknowledge the bill. Teetor said the Senate plans to “ride it out” and let the changes go into effect.

end of quote

I realize this isn't exactly the same thing as having the entire system on this since hospitals can replace state employees with private insured and makes us pay the extra money as state employees by switching to out of network. I have no idea how this standoff is going to turn out. In NC teachers and all state employees are on one plan run by the state. We are by far the largest insurance plan in the state and hospitals are telling us hell no. If we can't get hospitals to accept nearly twice the Medicare rate, just how is the government going to get the savings Medicare for all promises?

[Hassin Bin Sober]

1. How much do hospitals have to gouge paying customers because they are forced to treat non paying...

.... customers.

You know that level of payment that the hospital does accept from your current insurer also comes out of your pocket. Yes?

It’s your money.

It amazes me people are so upset about expanding the risk pool and removing the profit skim from their own money.

Insurance companies don’t innovate. They skim. And they thrive off an intentionally inefficient system while skimming the cream off the top while you are statistically young and healthy then lay you off on the most intentionally inefficient government insurance pool imaginable - old sick people. And they laugh all the way to the bank doing it.

[dsc]

2. there is a certain amount of cost

and unless you get that cost out, then there won't be a ton of savings. The fact is as of right now, state employees are likely to have to either have a very restricted network or pay through the nose for our medical care if this plan goes through. I have one hospital in my town, and apparently it isn't taking the plan (it is a UNC hospital). So my choices are to pay vastly more for my care, or travel some distance to get my care.

[Blue_true]

4. Do you have a large number of retired people in your state?

Here is my part of Florida, the hospitals are mostly serving Medicare patients and surviving pretty well. There are lots of drug stores, doctor's offices, optometry and eyeglass shops. It likely helps that there are not that many tier1 employers in this part of the state that can pay for top employee health insurance. The hospitals here figured out a way to make it work, the ACA was a boon. There is a big Oncology center under construction, and several Heart centers either running or under construction.

I don't see why the hospitals can't get by with Medicare x 1.75. Of course North Carolina has more technology companies than Florida and bigger banking and investment companies, so the private pool likely is larger in NC and the hospitals have grown accustomed to that.

[dsc]

5. I don't know percents but we are somewhat of a retirement haven

warm weather, golf courses etc. We didn't expand Medicaid which isn't great and I don't know Tricare's reimbursement rate (we have a lot of active and retired military).

[Blue_true]

6. Florida didn't expand Medicaid either.

My older brother has been in the hospital two times in the last year. The place was full of old people, looks like that is how the hospitals make money, they certainly don't seem to be suffering.

[SouthernProgressive]

3. I think cost is a poor argument.

Not just for the specific reason you mention.

The transition is going to happen slowly. It’s not going to be M4A. M4A isn’t even M4A.

It’s going to be expensive. That’s the reality.

I’m all for a single payer system. The changes necessary to get us there are huge.

If I’m going to debate it’s merits on cost, I’ll just say that I want lower and middle income families to have guaranteed quality care without it bankrupting them.

It should be considered a right.

[Celerity]

7. and that is the MEDICARE rate vastly (almost doubled, ie 1.75 times X) increased

and they are still saying hell no. Imagine if the public option is pushed out (like Biden and others at times have said) at the MEDICAID rate, which is around a third LESS than basic Medicare reimbursement rates. The payback rates would be FORTY PERCENT of what those hospitals and doctors are already saying hell no to. So many doctors already now refuse to take Medicaid patients.

Between that and the 110-strong moderate/centrist caucuses in the House (let alone the Senate, even if we somehow win it back at 51-49 or even 52-48), I am very pessimistic even the public option is going to get enacted (let alone the pipedream of M4A.)

Hell if the ACA is fully tossed out by the SCOTUS, good luck even getting that half-measure (half-measure other than the wonderful pre-existing conditions clause) rammed through in any sort of workable form.

Big healthcare (ie hospitals and physicians), big insurance, and big pharma have a death-grip on our for-profit, broken healthcare system. Structurally and electorally, it is a labyrinthine nightmare to extract them from simply blocking any and all truly large, long term reform. Even without any interference at all from the Rethugs, the ACA premium and deductible rates would have went through the roof.

[DonViejo]

8. Locking...

You have posted your OP in the Democratic Primaries Forum, the news article has nothing to do with the Democratic Primaries for President. Please post your OP in the General Discussions Forum and/or the North Carolina Group.