At today’s
public hearing, the Cabinet got a lot of thanks for the hard work, but not a
lot of support for the proposals. Unfortunately the meeting was poorly
attended, especially by some of the strongest proponents of downside risk.
Speakers included providers, advocates, a SIM official, a foundation, and business
representatives. Many spoke against downside risk, noting that it could jeopardize
hard-won progress, that it is untested and we should wait and see how current
reforms perform, concerns about changes at the federal level, and that the
looming state budget deficit make any investments unwise. Prospect Medical
Holdings, the for-profit company based in Los Angeles that bought Waterbury
Hospital and ECHN, offered that if the state would give them a capitated fee
for Medicaid and they would save the state millions. They must not be
aware of the “spectacular failure” of capitation in our Medicaid program. Since
we shifted away from capitation, quality and access to care are up, fewer
people are visiting the ER for non-urgent care, and per person costs are down.
