GPhA fights Centene-WellCare merger

Centene and WellCare — two of Georgia’s Medicaid managed care organizations (MCOs) — want to merge. And, GPhA is urging Insurance Commissioner John King not to approve the merger.

During what turned into an almost four-hour hearing, the commissioner heard arguments for and against the merger. GPhA went to bat both in person and with a detailed follow-up letter, laying out just how bad this merger will be for the state by diving deep into the numbers to rebut Centene’s arguments for expansion. (You can read the letter here.)

GPhA built a coalition of support with our friends from the Medical Association of Georgia and the Georgia Society of Clinical Oncology, both of which joined in the case against the merger. That is our advocacy team at work, fighting for pharmacists and patients.

It doesn’t take an economics degree to see that giving one company control of 61 percent of Georgia’s Medicaid patients’ healthcare is a recipe for skyrocketing costs and wasteful spending. Yet that’s what Centene was asking for, and that’s why GPhA was there, fighting to prevent a bad deal for the state.

With CEO Bob Coleman in attendance, VP of Public Policy Greg Reybold pulled together a formidable team to testify against the merger. (A big thank you to Benji Black, Laura Ko, and Loren Pierce, for coming to speak out against the merger!)

What Centene is proposing would create the nation’s largest Medicaid managed care organization. It’s bad enough that PBMs already take a huge chunk of the state’s Medicaid dollars to “administrate” prescription drug benefits*. MCOs have their fingers in the pie as well: For every Medicaid dollar the state spends, it pays Centene Management Services (or one of the other MCOs) between 10.5% and 11.5%.

That’s hundreds of millions of dollars Georgia spends on “healthcare” that just pays private corporations to manage the process. Now Centene and WellCare want to merge to get a larger market share, less competition, and a bigger slice of the taxpayers’ pie … and they have the nerve to say this will somehow be good for patients.

Just trust them.

But apparently even they aren’t quite sure of the economic results. In one document, Centene says that “economies of scale” will make this mega-MCO cost less. (Hint: That’s not how economies of scale work.) Then, in another, it flip-flops and says it won’t really know the impact on Georgia Medicaid until after “an initial transitional period.” And Centene repeatedly claimed there would be no layoffs … so where will these economies of scale come from?

Finally, if you got this far and haven’t been shaking your head, here’s another bit of information to consider: According to survey data, Centene and WellCare aren’t even very good at what they do. In half of performance measures, both companies were ranked below average.

Now they want to merge. And Georgians will pay for it.

Here’s the story from GeorgiaPol. Read it. Share it. We’ll continue to keep you informed.

* A staggering 25 percent of Georgia Medicaid’s prescription drug spending didn’t go to pay for drugs — it went to pay PBMs. We’re talking $27 million for “administration.”

** By the way, Centene has an ownership stake in two PBMs … but please don’t call it “double-dipping.”

And then there were six

Deaths from the ‘mysterious lung disease related to vaping,’ that is. Lots of ideas about the cause, but no firm answers.

Nutrition help for Medicare patients

Got Medicare patients with diabetes? Did you know that Medicare covers “personal nutritional counseling” with a dietician? A lot of people don’t realize there’s a benefit waiting to be taken.

The estimated 15 million Medicare enrollees with diabetes or chronic kidney disease are eligible for the benefit, but [the program] paid for only about 100,000 recipients to get the counseling in 2017.

Two minutes on health insurance

The number of uninsured Americans has risen for the first time since the Affordable Care Act took effect.

The uninsured rate rose from 7.9 percent in 2017 to 8.5 percent last year, amounting to nearly 2 million more uninsured people, as experts said the Trump administration’s efforts to undermine the Affordable Care Act were partly to blame.

Georgia has slipped (sort of) — it now has the third worst rate of uninsured people, behind only Texas and Oklahoma; 13.7 percent of Georgians don’t have health coverage. (I say “sort of” because we’ve always been either third or fourth from the bottom depending on which stats you use.)

That said, a lot of them are eligible for either Medicaid or federal subsidies, but aren’t taking advantage of them. (That percentage is obviously higher in states with expanded Medicaid, but still.)

Why not? Many say they still can’t afford one, but others don’t think they need insurance or don’t realize they’re eligible for free or discounted plans.

The long read: Insurance fraud

Medicare and Medicaid are pretty good about going after fraud. But private insurers? Not so much.

“We Asked Prosecutors if Health Insurance Companies Care About Fraud. They Laughed at Us.“