Fallout From Failed Budget

Governor Christie walloped seniors and the disabled over the head last Thursday when he penciled out several items in New Jersey's budget for the upcoming fiscal year, including Medicaid funding.

In one respect, the State kept going. But items that lobbyists and legislators had thought were safely berthed in this vessel of funding for 2012 were clobbered as though with a rogue wave.

That rogue wave would be Governor Christie. Ocean currents are charted and fairly predictable, but every once in a while a ship reports an enormous over-the-bridge specimen that swamps a ship. It remains to be seen if New Jersey is going to sink under this latest wave, but our ship of State is listing.

The transitional aid cuts to cities hits Trenton hard. Last November, Mayor Mack came back with almost $30 million in his package and it was written into the budget. However it came with strings attached and the Mayor has not kept those strings tied in a bow. Hence, no aid in the State budget for Trenton.

Examining the Medicaid issue is also not what it seems to be at first blush. The Governor is pushing for managed care for Medicaid clients. This is a mixed bag.

Insurance companies are quietly buying up doctors groups. This means that doctors will be working for insurance companies. You thought that "panels of death" were something that hung over your head if the Federal Government had everyone on Medicare?

Well, hang on. Here is how managed care works:

I had a rupture in my knee. The managed care doctor was given points if he could keep his patients visits to a bare minimum and at a low tier of service. If memory serves me, the company provider was Cigna.

Well, Cigna did not approve orthoscopic surgery so I was prescribed a brace and sent back to work. I was forced to wear it, hobbling with obviously deteriorating effects, until it got so bad that there was no option but surgery. Next?

The pounding on the damaged limb shattered my ankle (previously broken and healed a decade earlier) which now required surgery on the ankle as well as the knee. But wait...here's the best part....the surgeons wanted to do the surgeries at the same time, same time same day same anesthesiogist...but Cigna said "no".

Yep. Cigna said "no way" and it had to be done as though it was a different injury. The upshot was that we went through the knee surgery, recuperation, rehabilitation, and it was only after the rehab "plateaued", because the ankle injury prevented the full course of recovery and treatment, was the second surgery approved.

Now does that sound like it saves money?

The doctor, who was my primary at the time, was furious with me and told me to get lost! He had been hauled on the carpet by the insurance company, that he lost "bonus points" because I had needed treatment, and he wanted me off his books.

From one point of view, the doctors group will cost less because they will have dramatically reduced their malpractice insurance overhead. They will become part of the process and therefore should be able to concentrate on patient care instead of business matters.

The hospitals will cut down on insurance processing costs because they will have a lower volume of providers to deal with.

But what will patients get? They will have to find new doctors in many cases. However, many seniors are currently going nuts trying to find transportation to get to sites for all the tests their doctors insist on, many times over-testing just to cover themselves for malpractice reasons.

Warning: It seems to me that there is financial incentive to undertreat these needy Medicaid patients. This is the dark side of the Governor's agenda.

Also, in this depressed economy, and with the requirements by the Affordable Medical Care Act that everyone be insured, the income parameters for new New Jersey Medicaid applications seem absurd. I find it hard to believe that making over $130 per week means you have too much income for Medicaid.

My grandparents used to tell me that "money was not important if we had our health".
I do think the State has a responsibility here.

Well, Gov? I am open to developments.

And about the nursing home issues and cuts...that's for next time.

Seniors Rock.