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Mentally ill need expanded Medicaid

Florida Times Union - 4/12/2014

Take every serious issue with the health care system generally and double it when it comes to mental health.

Think fee-for-service is a hindrance for the health care system?

Consider what it does for a patient who needs time and a physician with only 15 minutes to give.

Add in the fact that half of all psychiatrists are rejecting insurance, according to the Cornell Medical College.

And the reality that as aging psychiatrists retire, fewer medical students are choosing that field.

It means that a "perfect storm" is coming, combining numerous mental health issues with too few people to treat them.

Jason Altmire, senior vice president of Florida Blue in Jacksonville, recited some of these challenges to a JCCI study group examining mental health.

He is a former congressman with a background in the health care field whose role now is public policy and community engagement.

Florida is Ground Zero for health care in part due to demographics, Altmire said. In the future, the entire nation will look like Florida does now with its abundance of aging residents.

Florida Blue realizes that the fee-for-service system has to be changed. So the nonprofit is forming partnerships with providers and reimbursing to reward quality and penalize overly high costs.

"That's a very exciting thing for Florida and the whole nation is watching how we're doing this," he said.

"What it means is that for the first time, providers and insurers are aligned on their incentives for the benefit of the health care consumer, the patient," Altmire said.

This is doubly important for mental illness because it tends to be a chronic condition that needs time and patience.

Both are in short supply in the health care field.CREATING A MARKET

The new health care economy requires market forces that don't exist.

"Right now when you purchase a health care service, when you're going to a doctor, you don't know what you're getting," Altmire said.

"You don't know if it will cost more or less than somewhere else or whether their outcomes are better than somebody else's. We want to move to a system where that information is right at your fingertips."

Obamacare did a good job of providing more access to coverage, but not as good a job on cost and quality, Altmire said.

One of the key parts of the access pyramid was expansion of Medicaid, which the Supreme Court shot down.

Now states have an option of taking Medicaid, and Florida is one state that has declined.

About 1 million Floridians would be eligible for Medicaid - but they're currently denied access to health care

"People will say, 'They still get treated. They show up in the hospital. So it really doesn't matter,'" Altmire said.

"Well, it does matter. Because they're showing up in the emergency room, which is the least cost-efficient setting for health care."

And everyone with health insurance pays a hidden tax for uncompensated care.

"Your rates are going to go up if we don't expand Medicaid," Altmire said.

"And they will go up dramatically if we have 1 million people in this state who don't have health insurance and they are still getting health care somewhere."FAILURE OF LEADERSHIP

There is no excuse for leaders in this state to give up $51 billion in federal funding to provide health care for 1.1 million Floridians through Medicaid expansion.

Last year, the state came close.

Gov. Rick Scott reached an agreement with the Obama administration to expand Medicaid in this state.

The Senate went along, but the House resisted.

However, other states with Republican governors and legislatures have worked out compromises.

Why not Florida?

Iowa has a Republican governor, yet it developed a compromise with the federal government that involved privatization.

It will be the third state to adopt a partially privatized version of Medicaid expansion.

And there are good economic reasons to expand Medicaid.

Safety net hospitals like UF Health (formerly Shands Jacksonville) need that federal revenue.

UF Health has been receiving a flat amount from the city of Jacksonville for years. Its efficiency has not been rewarded locally, so funds elsewhere ought to be accepted.

Health care is big business in Jacksonville and Florida.

Business will benefit from this infusion of federal funding.

Besides, when did Florida leaders become so picky about accepting federal funds?

They sure haven't been fussy about taking money for roads or dredging the river.

Gov. Scott, Senate President Don Gaetz and House Speaker Will Weatherford should visit Washington together and get something done on expanding Medicaid.

If they don't, it will be a shocking lack of leadership that will go down in history.FAST FACTS- 89 million Americans live in an area without access to mental health professionals.- 55 million Americans have no access to primary care.- 44 million have no access to dental care.QUOTABLE"I think everyone agrees that we need a (health care) system in this country where everyone has access to it. And nobody should go bankrupt because of health care costs. And nobody should be denied treatment for health care when it's required."- Jason Altmire, Florida Blue executive