Wednesday, March 1, 2023

Sid Salter: Is Subscription-Model Healthcare a Real Alternative to Medicaid Expansion?

Mississippians have, like citizens in many Southern states, argued for a long time over the question of Medicaid expansion. The arguments run the gamut from financial to moral to philosophical to purely political and usually intensely partisan.

The debate continues in 2023, a courthouse-to-statehouse election year in the state. In the wake of the Dobbs abortion case decision by the Supreme Court, the current debate has focused on increasing postpartum Medicaid care for mothers from the present 60 days to one year. In the state with the highest rate of infant mortality in the country and as the originating state for the Dobbs anti-abortion decision, an expansion of Medicaid for this purpose more than makes sense.

But the politics of Medicaid expansion in Mississippi is intensely partisan. One conservative advocacy group that has been monolithic in its opposition to Medicaid expansion for more than a decade is the Mississippi Center for Public Policy. The group is still opposing Medicaid expansion in Mississippi – currently on the basis that the Florida model of subscription primary care “ultimately costs less than regular insurance prices with better quality care.”

The bright line explanation for cheaper medical care in the subscription model is that they claim to remove the insurance companies from between the doctor and the patient.

For those with the means to afford private insurance of some kind, the subscription model may well be worth exploring. But as a substitute for Medicaid, serving some of the poorest people in America, the subscription model has many failures and shortcomings.

The subscription model requires a monthly, quarterly or annual payment, usually between $80 to $100 monthly, to pay for routine monitoring, checkups, comprehensive care and tests. But urgent care and specialized care are not covered. There is no health insurance to pick up the massive costs of catastrophic medical events like car accidents or long intervention battles with dread diseases.

Because of the lack of traditional health insurance, experts say subscription primary care customers need a health savings account (HSA) or a high deductible health insurance plan (HDHP) in case a car accident or cancer battle occurs.

To make those monthly primary care subscription payments, HSA contributions and HDHP premiums, there must be a steady stream of income. Perhaps subscription primary care works as a substitute for traditional fee-for-service health insurance. But as a substitute for Medicaid, the more likely outcome is that the Mississippian in poverty will remain uninsured.

As I’ve written before, regardless of one’s politics, taxpayers have and will continue to bear the brunt of healthcare costs for the poor.Two federal laws virtually dictate unreimbursed spending.

Many of the government-owned community hospitals in Mississippi were funded through the federal Hill-Burton Act, which originally gave hospitals built with federal dollars a 20-year post-construction mandate to provide free or subsidized care to a portion of their indigent patients. In 1975, Congress enacted an amendment to the Hill-Burton Program, Title XVI of the Public Health Service Act. Facilities assisted under Title XVI were required to provide uncompensated services in perpetuity.

The uninsured primarily receive uncompensated care. Nationally, uncompensated care in the U.S. is estimated to comprise over 55 percent of all emergency care delivered. That percentage is believed to be significantly higher in Mississippi's state-owned rural hospitals. Mississippi hospitals estimate they delivered $600 million in uncompensated care.

Second, there is the 1986 Emergency Medical Treatment Act (EMTALA) which was enacted by Congress. This act requires any hospital that accepts Medicare payments to provide care to any patient who arrives in its emergency department for treatment, regardless of the patient’s citizenship, legal status in the United States or ability to pay for the services – including medical transport and hospital care.

Also applicable under EMTALA is the requirement that every U.S. hospital with an emergency room has a legal duty to treat patients who arrive in labor. The law allows hospitals to bill patients and sue them for unpaid bills, but the odds of making recoveries from indigent patients are extremely low.

Subscription primary care serves people with resources. Subscription primary care may have a place in Mississippi’s healthcare arsenal, but it’s comparable to a Band-Aid on a severed femoral artery when it comes to Medicaid in Mississippi.


 

Sid Salter is a syndicated columnist. Contact him at sidsalter@sidsalter.com.

14 comments:

Anonymous said...

Thar he blows.

Anonymous said...

“Subscription primary care serves people with resources.”

Sid continues to wage war on people that have jobs and make decent life decisions.

F U Sid.

Unknown said...

i'm a believer that everyone needs some skin in the game and am adamant we could easily save 25% of the 600M in E.R. visits via telehealth which will eliminate a lot of unnecessary E.R. visits. For the record that's $150M in savings!

Anonymous said...

"The uninsured primarily receive uncompensated care" Duh

Anonymous said...

Sid-

Do you reaaly think $80 to $100 per month can be extracted from this bunch?

If so- think again!

Anonymous said...

The costs of health care for the poor are not “uncompensated”. They are paid by people who can pay or have insurance by way of greatly increased prices for medical care. Democrats, in their never-ending quest for the free lunch, either don’t or won’t see this.

Anonymous said...

Salter needs to stick with writing about things he actually knows about, if there are such things.

Anonymous said...

Not sure where Sid is getting his info from but...subscription care is primary care + urgent care. The only thing it isn't is major medical. The purpose of subscription care (or you can be fancy and call it concierge care) is to make the actual care portion of healthcare affordable. You're paying for access and care. Most providers in this space are available afterhours via telehealth and are not concerned with insurance billing codes. Novel stuff, being more interested in healthcare than health insurance.

Anonymous said...

When an individual can pay "out of pocket" the same amount for health care services that one with Blue Cross/Blue Shield (or other insurance companies) pays with a contracted rate for services, then it will be a step in the right direction to reign in healthcare costs. There is a reason why some don't want to have a true and transparent listing of cost for services at different providers. They know that folks will choose to go where the prices are better. And there is a reason why there are growing practices where doctors contract with patients to pay a monthly charge and get a "bundle of goods/services" in the way of medical care for that subscription.

As 1001 pointed out, there are doctors who want to provide care and actually treat patients, rather than be beholden to insurance companies and their matrixes of billing codes.

Anonymous said...

Mark my word, should Medicaid ever get expanded Salter will write a column arguing the expansion of coverage to illegal aliens in Mississippi. Take it to the bank.

Anonymous said...

I'm not opposed to citizens under age 18 recieving Medicare or Medicade.
There are practical considerations and the notion that the majority of these people never worked or tried to work is false.
Here in MS in particular, I know damn well many are those who did lawn work or housekeeping for whites who paid in cash or did minor repairs or painted homes or help with parties.
Some of those were replaced with illegals later.
There are probably many guardrails we could put on making government work better, but not when we are so divided as to be defensive or unreasonable. And, not when we refuse to face that NO organizational structure or system or "program" will ever be perfect. WHEN found, the SANE and practical thing to do is FIX or replace parts .
But thanks to "us/them" thinking, political INSANITY, and yes, racism, we "throw out the baby with the bathwater" without even looking to see what's in the tub!

Anonymous said...

@11:01

Did they pay into the system with these cash payments????????

Anonymous said...

I’m not sure that plan would have been very helpful for my wife’s cancer treatment. I don’t remember the cost of the surgery but the Chemo Bill before adjustments for insurance was $15,500 per month for 12 months.

Anonymous said...

If you don't feel an obligation to care for your fellow man, do you at least understand what a tremendous drag a sick ass population is on the economy and your pocketbook? Politicians use race and class, just like they do with everything else, to keep people stirred up and not thinking logically, so they can line the pockets of rich corporations who turn around and give them money. They don't even try to hide it. We are a state full of people trying to burn down our front porch so no one else can sit on it.


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If you get tired come relax at the Fox News Tent. To gain admittance to the VIP section, bring either your Republican Party ID card or a Rebel Flag. Bringing both will entitle you to free drinks.Get your tickets now. Since this is an event for trolls, no ID is required, just bring the hate. Bring the family, Trollfest '07 is for EVERYONE!!!

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