April CT Health Reform Dashboard – temporary relief at federal level but troubling payment model returns (again and again and again)

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CT’s April Health Reform Dashboard is somewhat more settled than last month – but that’s not a good thing. Efforts to repeal and replace the Affordable Care Act, plus cap Medicaid spending, were temporarily suspended, but are moving again at the federal level in the House. Despite the repeated lessons of history in CT, proponents of financial risk as the single solution to all that ails our health system are at it again. SIM is pushing a primary care capitated model for the entire state, despite extensive evidence that it doesn’t work, and that the primary care system is the worst position to accept financial risk. Thankfully the state recognizes that the model won’t work for Medicaid – but that hasn’t stopped SIM proponents from pushing ahead anyhow. Unfortunately problems persist in PCMH+, Medicaid’s current risky experiment with payment reform – ineffective consumer notices, political and conflicted interests driving policy, no evidence of a system to even detect underservice, and, probably worse, a plan to move ahead pushing another 200,000 people into the experiment before there is any meaningful information (much less a proper evaluation) of what happened to the first 137,000 people. No one is listening to cooler heads urging a moderate, prudent course of making sure people aren’t being harmed and taxpayers aren’t paying more before any expansion — and maybe fixing the problems – since when did anything this risky work perfectly the first time. Mistrust remains at the core of our problems.
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