A great deal of controversy has surrounded the exclusion of UCare from participation in the state’s Medicaid and MinnesotaCare programs (“Disruption of UCare rankles state legislators,” Aug. 24; “Caution needed on health plan contracts,” editorial, Aug. 15). State legislators are expressing concern, and UCare has brought a lawsuit. People are wondering whether UCare has somehow done something to justify what is being done to it — or perhaps UCare is being sacrificed to avoid an in-depth examination of how our state officials have managed (or mismanaged) these programs for many years.

In either event, it’s clear that our policymakers don’t want to ask, or aren’t going to ask, the questions that need to be answered:

1) On June 1, the federal government published new proposed rules dealing with Medicaid managed care. These rules contain an explicit prohibition of something called “rate-cell cross subsidization.” This is a fancy way of saying a state can’t use federal Medicaid money to fund or prop up other programs that don’t qualify for such funding.

Is this new federal rule in any way related to what is happening to UCare?

2) On Jan. 10, the Star Tribune published a commentary (“Counterpoint: A factual understanding of HMOs”) that discussed a $1.3 billion dollar “shift” of HMO reserve funds to the state of Minnesota. What is this? Who knows about this? Who authorized this? How long has this been going on? Is this shift temporary or permanent? How can such a shift be reconciled with the proper use of federal Medicaid matching funds? What does it mean for the integrity of Minnesota’s health care system if a large part of HMO reported reserves (funded in large part by the federal government) are not really cash on hand but rather some sort of IOU from the state?

3) Our nonprofit HMOs have always contended that precisely what they do with billions of dollars of tax money is a secret. Now our Department of Human Services contends that the so-called competitive bidding process that was employed to eject UCare is also a secret.

Is there anything about the operation of this $5-billion-a-year, publicly funded program that isn’t a secret?

4) Last year, when Minnesota debated and ultimately passed a law that might have given the public some access to health plan data, our HMOs cried foul and demanded that this decision be delayed for one year to avoid harming or inconveniencing them. Our legislators immediately gave them this reprieve (you wouldn’t want to rush into disclosing to taxpayers what is done with their money).

Isn’t it odd that when the issue does not involve disclosure of HMO data but rather the displacement of 475,000 vulnerable public-program enrollees, there isn’t a minute to spare, and UCare and South Country Health Alliance must be destroyed posthaste?

5) The further consolidation of Minnesota’s already-concentrated health insurance market is not just bad for public-program enrollees, it’s bad for all of us who are now required to buy insurance from the survivors of this secret process. Who will watch out for our best interests? And when will they start asking the questions that need to be answered?

 

David Feinwachs is a St. Paul attorney.