11/20/13 Federal Exchange in Mississippi Equivalent of Medicaid

In an effort to limit costs, as any insurer is wont to do, Magnolia Health Plan in Mississippi has signed up all the Medicaid healthcare providers, and not one single provider more. Among the president’s many claims that are not panning out, his claim, “If you like your doctor, you can keep your doctor,” is false. If you are forced onto the exchange, it is very likely that you cannot keep your doctor, since your doctor will not be participating.

I also find it nearly dehumanizing that the flagship of places in Mississippi where one can receive the cutting edge of medical treatment, The University of Mississippi Medical Center (UMMC) in Jackson, is not a network health care provider, and it is a public hospital, owned and operated by the State of Mississippi. UMMC is famous for taking charity cases, regardless of one’s ability to pay, for anything up to and including heart/lung transplants. I once had an impecunious friend who received a hernia repair there and they charged him a dollar.

Magnolia Health Plan wants to discourage any possible advanced medical procedure by not having UMMC in network. UMMC takes Medicaid patients and undoubtedly would take Magnolia Health Plan enrollees, but Magnolia Health Plan has excluded them, apparently with the sole intent to limit choices. This is beyond reprehensible, particularly since Magnolia Health plan offers ZERO coverage for out of network providers, not the 50% typical of all other insurances.

I visited Magnolia Health Plan’s website and was further discouraged to learn that they encouraged you to choose a Primary Care Facility, but in all but a few, the physicians listed were not accepting new patients. Nor were many of the Nurse Practitioners accepting new patients. In my home county of Kemper, since there is a new hospital and clinic, they had several physicians listed that were accepting new patients, but those same physicians were listed as the physicians in a dozen different clinics owned by the corporate parent, which means that you’d likely wait hours to see the one (whichever one) happened to be on duty in the clinics . . . you’d most likely see a nurse practitioner.

Primary Care Medicine is headed towards nurse practitioners everywhere, since there seems to be a dearth of Primary Care Physicians, and we are warned that this will only get worse with the influx of millions of people into the insured system.

As I indicated in another post, Magnolia Health Plan only lists one single oncologist/hematologist in their entire system. Even if you pull up Jackson, you are still pointed to Dr. HemoColumbus, in Columbus, Mississippi. There are other physicians in her practice, but none of them are listed on the Exchange website. They are listed on Magnolia Health Plan’s website, but they are not accepting new patients.

I googled Dr. HemoColumbus. She is fresh out of a medical residency in Hematology/Oncology and a brief practice in Jackson, Tennessee, and is board certified in both. She is likely to be very busy since she is the only oncologist listed for a population of over 750,000 folks. Granted, not all of those folks will be on the exchange, but it is still likely that she will be very busy…so busy in fact, I’d say that in just a few years or so, she will likely not be accepting new patients, or gone off to some place where the doctors receive more compensation than what is likely coming to them from Magnolia Health Plan. After all, Dr. HemoColumbus was recruited away from her practice in Jackson, Tennessee to come to Columbus. Is it not possible that she could be recruited to somewhere else? Who will take her patients then? Her non-new-patient-accepting physician colleagues?

She may be the best oncologist in the whole wide world, but under Magnolia Health Plan, it won’t matter if you don’t like her, or if you think she is incompetent, or have no confidence in her, because you will have no other option. It’s Dr. HemoColumbus or none…and your CFNP can’t treat you for CLL, nor can whichever physician happens to be present in the clinic, or sort of present yet readily available, or at least able to answer his cell phone, because in Mississippi, nurse practitioners must practice under the supervision of a physician…they cannot have their own practice. This may be different in your state…and there is a movement afoot in Mississippi to allow CFNP’s their own practice, but this is being resisted by the physicians and their powerful lobby in the state legislature.

All of this is incredibly complicated, and it is also a moving target. Many things will shake themselves out and improve as Obamacare gets going, provided the Democrats don’t kill it first out of terror of the 2014 elections, or through their many fixes, all of which are being engaged to sway the public back to their side but are damaging to the way Obamacare was designed to work. The Democrats are even adding more fuel to the fire that is burning them by delaying the employer mandate until next year, when it will have to be implemented just a few months before the election. Expect this to get delayed again.

The administration is talking about more waivers for “certain self-insured groups” which is directly translated to certain union organizations who have Taft-Hartley type plans, such as the SEIU and affiliates of the AFL-CIO. Congressional tomfoolery is being watched carefully, too, since they asked for and accepted an administrative waiver of the Grassley amendment, which Louisiana Senator David Vitter is trying to get reinstated. Vitter is proposing an amendment which will require enforcement of the Grassley Amendment. That is about as a\effective as passing an extra law making gun crime double-extra-illegal. First, crime is already illegal, crimes committed with a firearm are doubly illegal, and an additional law will simply make it trebly illegal, but will not stop anything.

I do not want Obamacare to fail, but I also do not want 2,000 pages of legislation which yielded an additional 7,000 pages of regulations, all of which can be enforced or waived or modified by the administration seemingly at will. This is not law. This is not law and order. This is disorder. This is chaos. The chaos of it is evident in its own application, and in its own misapplication. I don’t know that it can be fixed.

The Republicans must offer fixes that make medical and economic common sense. It is not enough to merely criticize what others are doing. If the law is to fail, then something must be put in its place: something that works and does not set the entire medical system on its arse. It seems likely that intelligent men of both parties should be able to come up with something that will allow folks to obtain health insurance that is affordable, and do that in about twenty pages or so. If we can’t do that, we’ll wind up with far more than just the Department of Health and Human Services, we’ll wind up with The Department of Health Care AND The Department of Human Services. Creating a whole cabinet level department and separate bureaucracy will not make things better; it will only make it worse.

Of course, having seen it before, the Republicans are very likely to blow any advantage they might gain from the Obamacare fiasco. If they are smart, they will remember their own sad fortunes of just a few weeks ago with the Ted Cruz/Filibuster/Government Shutdown, and remember how quickly things can change. Any fixes or changes must be transparent, must be real and not just for political showmanship, and must be done for the good of the people and the country and not just with the next elections in mind. There should be no more misrepresentations (lies). The people are on to this now, and no one is in a very trusting mood, having had the trust abused, harshly, in a manner that is evident to everyone, even loyal Democrats who are now scrambling for cover.

Congress must stop illegally abdicating its constitutional authority to the Executive branch. The Executive branch must stop choosing to enforce or not enforce law based on its political whims, nor continue to unilaterally set aside law. The Judiciary must draw some lines for these two branches if they will not police themselves. Chief Justice John Roberts warned us, in finding a way to make Obamacare work without expanding the government’s power under the commerce clause, that it is not the job of the judiciary to decide whether a law is good law, nor to determine matters of policy beyond the measure of the law’s or policy’s constitutionality. I think he was right.

The Republicans in the House should also stop having so many hearings, especially if they are going to allow themselves to be emasculated by refusing to issue subpoenas or having their subpoenas ignored by those in the Executive. This makes for exciting TV and blog posts but is not connected with good government. Maybe if the Executive branch was as transparent as it claimed it would be, no one would think that is necessary.

Tacitus said, “The more numerous the laws, the more corrupt the state.” By Tacitus measure, alone, the 9,000 plus pages of Obamacare law and regulation admit of corruption. Our state is corrupt.

Excuse me, but we are in a sorry state.

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