Guest commentary: Medicaid proposal’s path through Missouri Legislature is a warning sign

Missouri stands on the brink of prematurely privatizing management of Medicaid for 240,000 low-income adults and children to three for-profit companies to the detriment of very vulnerable patients.

It does so through a process that was highly irregular. As is often true in the capital, a member of a key legislator’s staff is now employed by the companies that stand to profit from policies advocated by that legislator.

These are signs of danger we should heed.

The General Assembly legislated statewide managed care in 2015, but it used a spending bill to do so. There were no hearings to take testimony from stakeholders, and no legislation passed authorizing the move.

Under a managed care system, several private companies work with Medicaid patients, overseeing their care. We believe managed care does not serve the best interests of Medicaid patients in the state because a financial incentive is at play to limit or even deny care.

A coalition of 13 health, labor and community-based organizations agreed. They sent a formal request to Gov. Jay Nixon calling for the state to cease movement to statewide managed care despite the language in the spending bill.

But those requests failed. The organizations received no response from the governor, and the state continued to move forward toward implementation.

The Department of Social Services released a report showing that fee-for-service performed better than managed care on 10 out of 18 quality measures it examined. Still, the movement to statewide managed care rolled steadily forward. We think the corrosive power of money in politics and the lack of strong ethics rules in our capital are major reasons why.

In 2015 and 2016, former state Sen. Kurt Schaefer was chairman of the Senate appropriations committee and a powerful advocate for statewide managed care. He also was the recipient of several large campaign donations from managed care insurance companies.

Schaefer’s chief of staff was Yancy Williams. Williams is now executive director of the Missouri Health Plans Association, which represents the managed care companies operating in our state.

Too often in this state, those who legislate in specific issue areas or who regulate certain industries become well-paid executives in those companies shortly after leaving government employ. This kind of action feeds the perception of corruption that made such a powerful impact in the 2016 election cycle. Voters clearly expect elected leaders to clean up such revolving door practices.

We are nearing the end of another budget cycle. The General Assembly now is routinely legislating by appropriation on matters of Medicaid managed care. This is true even though the Missouri HealthNet Oversight Committee has voted multiple times against statewide expansion of managed care.

Premature implementation of statewide managed care could mean windfall profits for insurance companies. But what will it mean in terms of the health of MO HealthNet consumers? Missouri should reverse course before significant harm is done.

This story was originally published May 3, 2017 at 8:30 PM with the headline "Guest commentary: Medicaid proposal’s path through Missouri Legislature is a warning sign."