Text of Speech Against Managed Care on August 12.

On August 12, scores of people with disabilities who are against a new program, that will force 40,000 people with disabilities into managed care, rallied in downtown Chicago. During the program in Daley Plaza, Tom Wilson of Access Living delivered a speech against managed care and the new program. Here is the text of that speech –


Thank you for coming. My speech today is to explain why we are here today. We are here in the streets to show opposition to the pending cuts to health care for people with disabilities in six counties in Illinois through the introduction of a Medicaid Managed Care Pilot.

The state has proposed an HMO style Medicaid Managed Care system that would place 40,000 people with disabilities into one of the 2 HMO programs administered by the 2 insurance companies selected by the state.
This will be a capitated program where the state will give the insurance companies 1,039 dollars for each consumer they have enrolled in the program every month whether the consumer uses any health care services or not.

We have many concerns about Medicaid Managed Care:
There has been a lack of input by people with disabilities and their advocates. State planning began in the summer of 2009 but it was December of 2009 before we learned that this was going on. Stakeholders meetings have been held but we have not seen any substantial changes made in the Request for Proposal or in state objectives resulting from the many criticisms and challenges.

Accountability is a concern. We know that the state is not responsive to all the problems we have identified with Medicaid but individual advocacy has been able to be successful because the state is sensitive to political pressure. We view insurance companies as more impervious to pressure. They have a dominant imperative which is to make money for the share holders.

We fear that people who have established good relationships with their doctors will be forced to change to a different primary care physician. We know numerous people with disabilities who have invested considerable time and energy into finding a doctor who understands them as a person and who understands their disability. This is a very important relationship for them. They do not want to change doctors. The ability to freely choose your specialists is doubly important to some people with disabilities. Some people with disabilities use a specialist as their primary physician. They may have a condition so rare that few specialists have had real life experience monitoring and treating it. Managed care has been known to make it more difficult or even impossible to see the specialist you need to see.

Managed Care has a history of limiting access to Physical Therapy, Occupational Therapy and other therapies that help people to maintain functional levels or help to train individuals with disabilities to deal with the physical and social barriers that exist all around them. People with disabilities require easy access to these supports by health professionals.

Durable Medical Equipment is expensive. One way Health Maintenance Organizations (HMOs) make money is by denying access to costly durable medical equipment. Sometimes they have tried to substitute cheaper and less adequate devices for the equipment that best serves the person. People with disabilities quality of life can be greatly impacted by the lack of timely access to high quality durable medical equipment.

It is not clear to me that the appeals procedures will be timely enough in response to emergency situations. Currently you can change doctors or hospitals if the doctor you have chosen is denying necessary medical treatments. This is an important protection for patients.
Accessibility has been a large problem for people with disabilities in medical settings. Few doctors and hospitals have complied with the Americans with Disabilities Act guidelines to provide accessible examination tables, diagnostic equipment and treatment facilities.

Programmatic access, such as access to TTYs and sign language interpreters at medical settings continues to be a big problem. Will these HMOs be compelled to identify ADA compliant facilities? Will the HMOs be ADA compliant themselves? Will there be enough accessible providers within a reasonable distance of each consumer?
We have grave concerns that the Medicaid Managed Care will mess with consumer controlled long term care. The Home Services Program that is available to Department of Rehabilitation consumers is known to deliver a high level of satisfaction in a very cost effective way. Consumers can hire, fire and manage their personal assistants and decide when they want the services. This means that almost every dollar the state spends goes to the home care worker because the consumer is doing the management function. When a third party like an HMO is injected into this situation, 2 things happen. The consumer loses control over their services and the consumer loses service hours as the money is now siphoned away from care to pay for unwanted management and coordination functions provided by the HMOs. Both things are bad for the consumer.

Why is the state doing this now? It is to save money, of course. The state is in a huge financial crisis and with this pilot their announced goal is to save 200 million dollars. That breaks down to $1000 per person per year in reduced health care spending. That is money that would otherwise go to health care. On top of those cuts, the 12% of the monthly capitation rate that is paid to the HMO for management, case coordination, processing paperwork and profit will come out of money currently being spent on health care. These are serious cuts in financial resources going to health care. HMOs don’t provide any health care. HMOs don’t bring any expertise in disability. HMOs bring in an expertise on denial of care and in making money.

It is important to look at the health care in a national context as well to understand what is going on. The new health reform law will add millions of people to the Medicaid rolls. The insurance companies see dollar signs. They all want a piece of this new action.

In order to gain or keep managed care contracts, how much money will we see these HMOs contributing to our politicians? Will the HMO donations get the politicians to serve their interests? Who will protect the consumer interest? It already seems that our state is listening to the corporations more than the citizens.

We say:

Let us choose our own doctors! Don’t put an insurance company between us and our doctors! Don’t put an HMO into our Home Services!

Tom Wilson

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