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MPPA Meeting Thursday September 14, 2017 at 6 PM in Central Medical Building, St. Paul.

Thursday, September 14th, 2017

Those present: President Lee Beecher, Bob Geist, Dave Racer, Hannelore Brucker, Carl Burkland, Don Gehrig, Wayne Zuehlke, Mike Ainslie, Dave Feinwachs, Tim Herman, and Doug Smith.

1. Minutes of the May 16, 2017 meeting had been circulated to all before the meeting and were not discussed further.
2. 2017 Senate Select Committee on Access and Cost was discussed by RWG. The committee Chair, Sen. Scott found himself unable to get to the meeting and sent his regrets.
3. 2018 Legislature. David Racer and Feinwachs led the discussion.
• It was noted that the Reinsurance bill passed this session had some serious problems, especially since MCHA was not revived—MCHA ought to be a priority.
• The fate of the Health Care Access fund (and provider tax) remains problematic.
• The new option for discounted fist dollar care coverage (by Golden Rule and UHC corporation) was briefly discussed—catastrophic insurance would be needed.
• It was noted that with Guaranteed Issue (GI) and Community Rating (CR) there is no true insurance underwriting—the corporations are on the public-private dole. One person observed that the ObamaCare promise was that, if you back the bill, we’ll give you all the patients and the money—the result is the corporations complain that they don’t get enough money with all the patients. Trump so far is not coughing up the dollars; if the mandate is not enforced, the “plans will collapse.” [IMO, maybe. But we got what was a medical system handed to government protected HMO-ACO cartels as a path to UHI—this time to commercial corporation health services or corporate socialism (aka “privatization”) unlike to national socialized NHSs as done abroad—RWG.] The corporations are looking at a bipartisan Congressional recue at this moment.
• The HMOs make their money in Medicaid. [The expensive disabled are steered into the FFS sector (run by DHS); the well are steered to the Medicaid HMOs (aka “cherry picking”). Confirmation came from DHS, this morning: “MA recipients with a disabled basis of eligibility are excluded from this requirement (to enroll in HMOs) and largely served under fee-for-service.”
• A problem has occurred to those age >55 no Medicaid. They are finding out that their homes are being owned by the government with liens based on how much premiums would have cost; not on how much was spent on their care—if they had no Medicaid expenses, they could still lose their house. Apparently, folks have found out and are dropping out of Medicaid. The legislature has not corrected the problem.
• The problem with MN Medicaid is that the HMOs are spending state money but claim that how it is spent is a “trade secret” (i.e., proprietary information). DHS thus has no idea how money is spent on enrollees [with exception that a childless adult cost $7,992/person in 2016—RWG]. If federal block grants happen, full disclosure of encounter data ought to be mandated.
• The Hi-Lex vs. Michigan Blues was brought up because Medicaid is a self-insurance program akin to a private company ERISA self-insurance program—Hi-Lex is one of thousands of such ERISA companies using HMOs as TPAs. Medicaid uses HMOs as 3rd party administrators (TPAs). The MN HMOs would have us believe they are “at risk” insurance companies yet they tell the state what was spent and the state “believes” it and pays up—without an audit! Hi-Lex won the suit in 2015 with the result that the Blues illegal fraud cases have jumped to > 200 all of which the Court said shall be paid without question. [There remain efforts to open-up Medicaid HMO books to see, if MN (and CMS) Medicaid has been similarly defrauded. No state audits have been done!
• Action item for Dave Feinwachs: It was suggested that members co-sign a letter to the Office of the Legislative Auditor (OLA) to obtain paid claims data—many agreed; Dave Feinwachs will arrange.]
4. Family Medical Account bill. RWG discussed his testimony to the Senate Select Committee last week. A copy of the FMA briefing letter was handed out and was previously attached to the emailed agenda. FMA program is basically a method of FFS payment for Medicaid enrollees in categories families with children and childless adults. Mike Ainslie wondered if this could be used for the disabled—this is not in the bill but ought to be considered for a separate bill for a program of Personal Health Budgets for high need patients. [Pilot studies have begun in the UK NHS of all places—RWG. See O’Shea L, Bindman AB. Personal Health Budgets for Patients with Complex Needs. N Eng J Med. 2016;375(19):1815-1817.]
• Action item for RWG. I hope to get hearings on the FMA bill when the legislature re-convenes.
5. Other legislative items.
• Tax-free insurance equity for those not in employer-based insurance is a federal, not State issue.
• Out-of-pocket expenses credited to deductibles (the Fairness bill) for out of network care failed in the legislature so far.
• “Up to 50% of EHR data entry clerking” is an unpaid expense for un-paid data collection mandated by state law. It was suggested that using the VAH system (a public free EHR system) cold break the strangle hold on the IT involved.
1. Action item for Smith Racer, RWG: [All members were sent an email this morning regarding the IT problem and it ramifications thanks to the work of Doug Smith and Dave Racer—please note the recommendations of how to deal with the problem using legislation to negate a bad law—RWG].
6. MPPA. It was pointed out that MPPA is an excellent irritant of importance stimulating political action thanks to the synergy of the group and its wide-spread connections. No one is alone, as long as MPPA exists and our many Fellows freely discuss the issues of political malpractice, which continues to threaten patients, professional integrity ( the covenant of loyalty to patients first), and has already resulted in toxic financial results for families and the nation.

6. The meeting adjourned at 8 PM—with the usual post meeting confabulations!

7. The next meeting will be sometime before the legislature re-convenes. Congressional acts may determine the MN 2018 legislative session activities. During this summer and fall, there has been and will be continuous member activity regarding the next legislative session.

Respectfully submitted,
Robert W. Geist MD,
Secretary pro-tem

MPPA Meeting Tuesday May 16, 2017at 6 PM in Central Medical Building, St. Paul

Tuesday, May 16th, 2017

Those present: President Lee Beecher, Bob Geist, Dave Racer, Hannelore Brucker, Carl Burkland, Lye Swenson, Don Gehrig, Wayne Zuehlke, Mike Ainslie, Dave Feinwachs, Jason Flohrs, Tim Herman, Doug Smith, and Rick Morris.

1. Minutes of the February 21, 2017 meeting had been circulated to all before the meeting and were not discussed further.
2. Book Review. Lee Beecher and Dave Racer gave us a book report on their collaborative effort, Passion for Patients. It has received positive reviews; high praise came for Greg Scandlen, himself a high quality and prolific author on health care issues. This review of a fine book by our own MPPA president proved to be excellent background for our discussions. Lee generously gave a copy to each of us in attendance. [Available at Amazon—hard cover or Kindle]
3. Legislature activities 2017. The discussion was to be led by Scott Jensen, but at 10:17 PM, well after our meeting closed, he was still sitting in the Senate chamber! Dave Feinwachs, Jason Flohrs, and Dave Racer led the discussion helped by the observations and opinions from our talented membership many of whom are still involved in grass root policy activities and/or at the state level with the legislature.

During the discussion, the issues in Peter Nelson’s Memorandum regarding Congressional actions on risk pools proved to be good background: we noted the demise of MN’s successful MCHA program, the promise of consumer-directed health insurance, and the necessity of real market prices (for services and insurance)—Peter’s analysis is again attached,

We discussed: “shoveling” money to the HMOs [one view of the re-insurance bill]; the demise of the fair-care bill, which would have made the HMOs recognize payment of deductibles outside Plan networks (killed by the HMOs); the demise of the AGs bill for oversight of sale of non-profit HMOs to the for-profits during which the enormous assets (some MN State Medicaid reserves) might be pocketed by the officers and Board members (killed by the HMOs)—possibly analogous to the Soviet apparatchik millionaires created with demise of the government and “redistribution” of its assests; and the failed attempt of the HMOs to regulate balance billing outside their networks.

The issues identified with Medicaid were future federal cuts; federal block grants; the problem of waste and expanded eligibility swelling Medicaid ranks and increasing costs; the public theology that insurance = medical care access; the drift toward single payer or a two-tiered medical system; the failure of government (socialized) care [tax props, false reported low costs hidden in government agencies and queues for the ill—RWG]; the drift to health care as a “right” instead of a privilege; and the difficulty of repealing welfare benefits; and the politics of pandering to voters with “free” care using other people’s (tax-payer) money. It was noted that if system goals were choice, prices, and a personal physician, the FMA bill, which we have been following, could fulfil these goals for Medicaid enrollees—HF 1552 and SF 1302 will hopefully be heard in the next session.

The consensus of the legislative discussion, if there was one, seemed to be that the Republicans (national and local) by actions and non-actions are in the process of committing political 2018 suicide, that the HMO tail continues to wag MN health legislation, and that the “Plans” are to still able to grade their own homework—as in trust us; everything is just fine.

Pertinent background: before the meeting Lee Beecher had circulated to all a NYT article regarding UHG scamming through trolling patient charts and upgrading codes—the US DOJ has joined the whistle-blower law suit! https://www.nytimes.com/2017/05/15/business/dealbook/a-whistle-blower-tells-of-health-insurers-bilking-medicare.html?mwrsm=Email Read on…

4. Medicare for all. The lively discussion was led by Dave Feinwachs; he said that we should let younger people buy-in (not free like after age 65). He said the premium would be a small fraction of what seniors now pay for Medicare A and B, as the employer-based subsidy is re-directed to Medicare. Unfortunately, we lacked time to hear how he thought this would function or what Medicare regulations would apply.

Critics noted that: Medicare price fixing had broken the back of medical practices; socialized systems abroad were becoming unaffordable despite overt rationing of access (queues); NHS “reforms” are endemic when queues eventually affect increasing numbers of voters; fixed global national budgets would mean bureaucratic rationing [unlike the flexible aggregate of millions of family budgets governing all other microeconomic sectors—RWG]; and we would likely evolve into a two-tiered UK-like system. Other suggestions included having the government create a stop-loss [re-insurance] system for insurance policies.

5. The meeting adjourned at 8 PM—with usual post meeting confabulations!

6. The next meeting will be sometime in the fall—Congressional bills/acts may determine the MN 2018 legislative session activities. During summer and fall, there will be continuous member activity regarding the next legislative session.

Respectfully submitted,
Robert W. Geist MD, Secretary pro-tem