“If we’re in a position to reallocate extra earnings from these firms, we might help hospitals keep open and preserve offering lifesaving care in our low-income and rural communities,” Koehler stated in a Could 27 press launch.
Illinois started taking steps to denationalise its trendy Medicaid program in 2010 underneath then-Gov. Pat Quinn, a Democrat. Former Republican Gov. Bruce Rauner accelerated these efforts, which had been embraced by Pritzker, a Democrat.
On the identical time, consolidations reshaped the insurance coverage sector targeted on Medicaid. Right now, a handful of publicly traded firms are answerable for one of the important capabilities of Illinois’ authorities: offering care to 2.6 million low-income folks, together with pregnant moms, folks with disabilities, nursing dwelling residents and foster youngsters, data present.
Earlier than Medicaid was turned over to non-public insurance coverage firms, the state paid every physician, clinic or hospital a charge for each Medicaid service rendered. Right now, the state pays the insurance coverage companies a hard and fast greenback quantity per member every month, whether or not the affected person obtained pricey therapies or no medical providers.
4 of the 5 firms declined to reply to the BGA’s written questions or requests for interviews. Blue Cross stated its monetary beneficial properties had been largely restricted to the primary months of the pandemic.
“Throughout the first half of 2020, we noticed sharp declines in elective care utilization, as shoppers had been reluctant or unable to hunt medical care as a result of ‘keep at dwelling’ measures,” stated Blue Cross spokeswoman Colleen Miller. “Within the second half of the yr, the pendulum swung the opposite path, and the deferral of care moderated with utilization ranges ultimately returning to almost regular ranges. Throughout this era, profit bills additionally elevated to cowl pandemic-related prices, corresponding to testing, analysis and remedy.”