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Reading Ann Marie Marciarille: Hospitals v. Insurers: Mississippi Version: The View from the Roasterie XX: October 28, 2013

Health care communism comes to Mississippi!!

Republican Governor Bryant forces Blue Cross-Blue Shield to keep Hospital Management Associates' rural hospitals in its network. The governor's position seems to be: Since I won't accept the ObamaCare Medicaid expansion, Mississippi's rural hospitals will have to close unless I force Blue Cross-Blue Shield to keep paying for its patients at them at the old contract rates. I cannot allow BCBS use it bargaining power to renegotiate the rates it pays downward. So I have to step in.

If only Chief Justice John Roberts hadn't issued his lawless decision in Sibelius vs. NFIB, then the extra dollars from the Medicaid expansion would be flowing to Mississippi's rural hospitals starting January 1, 2014--and Governor Bryant would not feel he has to be a health-insurance communist.

If only Governor Bryant were willing to follow Governor Brewer or Governor Kasich, say "hey! this Medicaid expansion is a good deal for Mississippi", and cross the Tea Party nihilists, the extra dollars from the Medicaid expansion would be flowing to Mississippi's rural hospitals starting January 1, 2014--and Governor Bryant would not feel he has to be a health-insurance communist.

Ann Marie Marciarille: Missouri State of Mind: Hospitals v. Insurers: Mississippi Version:

I love... Cowboys & Aliens for its retro edge. The story is ever the same, though the players may be altered slightly. And so it is with the epic battles between hospitals and insurers over network participation and rates. I tell my students these battles are among the hardest fought and most continuous in all of health-care contracting.... Occasional public glimpses over the bare-knuckled negotiations between hospitals and insurers occur when the negotiations threaten to blow up and plan enrollees are informed of impending changes to hospital "in-network" provider status....

What is going on in Mississippi takes one of these same kinds of disputes and writes it large. Negotiations have apparently broken down between the Blue Cross Blue Shield Network and Hospital Management Associates for-profit hospital chain.... After BCBS dropped these hospitals from their network, [Republican] Governor Phil Bryant issued an executive order temporarily (for a maximum of 60 days) reinstating these ten HMA facilities into the BCBS network on contract terms based on the old contract rates. Yes, the facilities appear to have been commandeered, and hospital-insurer contract rates have been set by the [Republican] Governor.... Whether the Mississippi Patient Protection Act of 1995 requirement that insurers provide "reasonable access to care with minimum inconvenience" means that BCBS cannot walk away from what it says is a losing deal remains to be seen [in court].

The real back story is that BCBS holds a near monopoly in some of Mississippi's health insurance markets.... And at least three of the hospitals are sole acute-care providers in their rural settings, deeply dependent on reimbursement from BCBS. This Mississippi story tells a tale of health-insurance market concentration... [and] the stark vulnerability of rural hospitals.... The possibility of non-existent rural networks has been out there for some time because of the high incidence of uninsurance in rural populations.

Governor Bryant is a well-spoken opponent of Medicaid expansion in Mississippi. In January he told a reporter, "I would rather pay extra to Blue Cross [to help cover uncompensated costs for the uninsured], rather than have to raise taxes to pay for additional Medicaid recipients." (You can read the text of that interview here: http://www.kaiserhealthnews.org/stories/2013/january/23/mississippi-gov-bryant-medicaid-interview.aspx).

Only it's not Governor Bryant paying extra--it's HMA's shareholders.

Somehow I think HMA's executives should have given a lot more to Governor Bryant's campaign. Just saying...

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