CT’s April Health Reform
Dashboard is somewhat more settled than last month – but that’s not a good
thing. Efforts to repeal and replace the Affordable Care Act, plus cap Medicaid
spending, were temporarily suspended, but are moving again at the federal level
in the House. Despite the repeated lessons of history in CT, proponents of
financial risk as the single solution to all that ails our health system are at
it again. SIM is pushing a primary care capitated model for the entire state,
despite extensive evidence that it doesn’t work, and that the primary care
system is the worst position to accept financial risk. Thankfully the state
recognizes that the model won’t work for Medicaid – but that hasn’t stopped SIM
proponents from pushing ahead anyhow. Unfortunately problems persist in PCMH+, Medicaid’s
current risky experiment with payment reform – ineffective consumer notices, political
and conflicted interests driving policy, no evidence of a system to even detect
underservice, and, probably worse, a plan to move ahead pushing another 200,000
people into the experiment before there is any meaningful information (much
less a proper evaluation) of what happened to the first 137,000 people. No one
is listening to cooler heads urging a moderate, prudent course of making sure
people aren’t being harmed and taxpayers aren’t paying more before any
expansion -- and maybe fixing the problems – since when did anything this risky
work perfectly the first time. Mistrust remains at the core of our problems.
