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The Boston Globe
GLOBE
EDITORIAL
Beyond
the health pool
February 15, 2006
THE
UNCOMPENSATED care pool, which pays hospitals and health centers
to care for the uninsured, has grown into an $800 million behemoth
that needs to be reorganized and shrunk as part of healthcare legislation
being considered at the State House. Inspector General Gregory Sullivan,
acting at the behest of the Legislature, has performed a valuable
service by exposing the shortcomings of a program that was not meant
to be what it has become -- a makeshift, incomplete health insurance
system.
To
be sure, the pool has paid for much high-quality medical treatment.
Sullivan, in a telephone interview yesterday, said almost all the
care is being provided to people of limited means who lack health
insurance. Attorney General Thomas Reilly is investigating the possibility
that hospitals may have intentionally overbilled the state, but
Sullivan doubts there was any criminality.
What
the inspector general did find was a sloppy billing system with
few of the oversights the state has imposed on Medicaid, its comprehensive
health insurance for the poor. The pool often paid better than Medicaid
for the same procedure because the state underfunded the latter.
Medicaid rates need to be raised to reflect the cost of care.
The
pool is a vestige of 1980s hospital regulation, when the state took
a bit off the top of hospital rates for insured people to make sure
the uninsured got care. Since the pool was created, the Cambridge
Health Alliance and Boston Medical Center have become expert at
addressing the special problems of the uninsured, and they have
gotten a disproportionate share of pool payments.
The
pool only pays for treatment at hospitals and health centers. There
is no emphasis on the preventative measures and routine office visits
allowed under Medicaid or private insurance plans. The money would
be better spent on regular health coverage.
The
Legislature is working on a bill that would do that, but it is delayed
by disputes over how many people will get insurance and who will
pay for it. Legislators ought to resolve this with a compromise
that mandates that everyone in Massachusetts be covered. Most pool
money should be reserved for coverage with enough left to address
urgent care for illegal immigrants and those who somehow slip outside
of the mandate. And payment should be regularized on the Medicaid
model.
The
Cambridge Health Alliance, Boston Medical Center, and other hospitals
that rely on the pool should be protected during the transition,
and special programs for the uninsured maintained if they have value
as these people get new health coverage. The pool has allowed Massachusetts
hospitals to provide high-quality care to deserving people, but
it must give way now to a better system.
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