Liberals Love Trump's Tax Plan... When Told It's Bernie Sanders' Plan

If so, perhaps this isn't about liberal and conservative, maybe its about IQ.

 

Well, and Insurer's made $Billions of Obamacare's medicaid expansion, just in CA:

Insurance companies are reaping spectacular profits off the taxpayer-funded program in California, even when the state finds that patient care is subpar.

Health Net, a unit of Centene Corp., the largest Medicaid insurer nationwide, raked in $1.1 billion in profit from 2014 to 2016, according to state data obtained by Kaiser Health News. Anthem, another industry giant, turned a profit of $549 million from California's Medicaid program in the same period.

Overall, Medicaid insurers in the Golden State made $5.4 billion in profits from 2014 to 2016, in part because the state paid higher rates during the inaugural years of the nation’s Medicaid expansion under Obamacare. Last year, they made more money than all Medicaid insurers combined in 34 other states with managed care plans.

Alan Sager, a health-policy professor at Boston University, was surprised — and dismayed.

"California is being wildly open handed and excessively generous with insurers," he said.

More than 1 in 3 Californians, or 13.5 million people, are covered by Medicaid — more than the population of Pennsylvania. About 80% of those in California's program are enrolled in a managed-care plan, in which insurers receive a fixed rate per person to handle their medical care.

California's payments keep flowing steadily even when patients fare poorly. Two of the most profitable insurers in California — Centene and Anthem — run some of the worst-performing Medicaid plans, according to medical quality scores and complaints in government records.

"If there is that much extra money sloshing around in California, then it's worth asking whether you could expect more in terms of performance," said Andy Schneider, a research professor with Georgetown University's Center for Children and Families.

California officials acknowledge they need to do a better job of connecting money and quality.

Before the ACA expansion, California's Medicaid plans collectively were barely in the black, with $226 million of net income for 2012 and 2013 combined. Traditionally, these insurance contracts have yielded slim profit margins of 2% to 3%.

But in the years since the health law took effect, many health insurers have posted margins two or three times that benchmark.

Centene's Health Net unit in California enjoyed a profit margin of 7.2% from 2014 to 2016. (Centene acquired Health Net for $6.3 billion in March 2016.) Anthem's profit margin in California's Medicaid program was 8.1% for 2014 to 2016.

Investors have cheered those results. Shares in Anthem have more than doubled since January 2014, when the Medicaid expansion began. Centene shares are up 50% since the company purchased Health Net last year.

With so many people's healthcare at stake, state officials say they did not want to risk having health plans come up short during the expansion.

As it turned out, they need not have worried.

In 34 states and the District of Columbia, Medicaid managed-care profits more than tripled to $3.9 billion in 2015 from $1.1 billion in 2013, according to consulting firm Health Management Associates' analysis of insurance filings. Those figures don't include California.

The federal government footed the entire bill for Medicaid expansion during the first three years, instead of taking the usual approach of splitting the costs with states.

In California, richer plans provided care of poorer quality.

The state scores Medi-Cal insurers from zero to 100% on how they perform on dozens of measures, such as diabetes testing, cancer screenings and checkups for children. Statewide, the average score was 63% for 2016.

For Centene and its Health Net unit, seven of its 10 regional health plans in Medi-Cal scored below average on quality. The company's San Joaquin health plan ranked last statewide at 31%. State officials have ordered the company to improve in areas such as ensuring women get postpartum care and providing routine eye exams and other tests for diabetics.

Among patients, a chief complaint is how hard it is to find a specialized doctor. In a March audit, Medi-Cal said Health Net "did not maintain an adequate number of specialists within its network." The state found that "member grievances on referral for services and availability of appointments with specialists were among the highest complaints."

Chandra Marshall, a Medicaid patient in Modesto, said she has suffered from limited access to specialty care.

She said her primary-care doctor in her Health Net plan recently recommended she visit a dermatologist for a biopsy. But she said the only available dermatologist on her plan was 90 miles away in San Francisco.

Worried she might have skin cancer, Marshall agreed to go but still hasn't heard back about an appointment.

"Why can't Health Net afford more specialists in the area?" said Marshall, who also suffers from kidney disease. "If Health Net doesn't provide access to dermatologists and other specialists, people may just risk not going."

Her Health Net plan in Stanislaus County scored below 50% on quality of care measures.

In the case of Anthem, eight of its 12 regional Medi-Cal plans scored below average on patient care (and the average 63%, or a D). The state has told Anthem to do better at providing prenatal care, controlling patients' high blood pressure and monitoring medications for asthma patients, among other issues.

The profits of managed-care plans feed into Republican criticism of the ACA’s costs and its expanded Medicaid rolls. President Trump has called for the law’s repeal, in part, because it enriches health insurers.

"They have made a fortune," Trump tweeted Oct. 13.

U.S. Sen. Ron Johnson (R-Wis.) has demanded that California and seven other states account for how they spent federal Medicaid expansion dollars. Johnson, chairman of the Senate Homeland Security and Governmental Affairs Committee, asked California officials in a letter Sept. 27 whether they have conducted audits and requested information on insurance company payouts.

The state's oversight has been less than efficient.

Starting in 2014, the federal government required that 85% of Medicaid expansion funding be spent on care and quality improvement efforts, rather than administrative overhead and profits. But three years in, California officials acknowledged they have just started audits.

What's clear is that insurers' spending on expansion and traditional Medicaid enrollees often falls short. Eight of California's 22 Medicaid insurers failed to hit 85% in medical spending for the year that ended June 30, 2016, according to state data obtained by Kaiser Health News. Anthem ranked lowest at 77%; Health Net spent 81% of Medicaid premiums on medical care, according to state calculations.

Each percentage point below the threshold can amount to tens of millions of dollars that should have been spent on patients.

In July, a federal rule went into effect establishing 85% as a national benchmark for all Medicaid managed care. Three months later, California Gov. Jerry Brown signed a law mandating that same percentage. But the state requirement doesn't kick in fully until 2023.

Michael McCue, a professor at Virginia Commonwealth University who studies Medicaid managed care, said the profit margins in California “raise a lot of red flags.” He said government officials owe it to taxpayers and patients to speed up their audits and do more to hold insurers accountable.

"You have to make sure you're getting a bang for your buck," McCue said. "Right now, [for insurers] California's Medicaid program is the golden nugget."

http://beta.latimes.com/business/la-fi-medicaid-insurance-profits-20171101-story.html