Why did HCMC undercut patient well-being?


Although one normally perceives hospitals, and the doctors who work in them, to be dedicated to the overall health of patients being served, HCMC (Hennepin County Medical Center) revealed that it compromised that ideal in May by lobbying against a bill intended to restore a basic right to Medical Assistance patients. Health Policy Advocates, our activist group, met with the HCMC spokeswoman in July to understand why HCMC would oppose a health care justice bill (SF404). In 2022, we got the bill, the Medical Assistance Freedom to Choose, introduced in the state Legislature and were confident that with bipartisan support—15 legislators signed onto it—it would be enacted in May of 2023. It would restore the basic right to Medical Assistance patients to choose whatever doctors and treatments they wished. Currently, state government routinely coerces these patients into managed care networks, depriving them of their freedom to choose to stay out of corporate control if they believe that is best for their health care needs. Our bill would allow all Medical Assistance patients to freely choose to avoid managed care, picking their own doctors, or to try the offerings of managed care organizations. Why did HCMC persuade a state senator to unilaterally prevent the bill’s enactment at the eleventh hour? The spokeswoman gave us information that reveals HCMC is more dedicated to its own financial operations than the well-being of its patients.
To understand this scenario, one needs perspective on Minnesota’s history with Medical Assistance. When the U.S. created Medicaid in 1965 to provide health care for low-income patients who couldn’t afford to buy it on their own, the federal government guaranteed their right to be treated by the doctors of their personal preference. In Minnesota, we use the term Medical Assistance instead of Medicaid. In 1988 our state government asked the feds for permission to put managed care organizations in charge of which doctors can be seen by Minnesotans on Medical Assistance. The feds granted that permission, and the state pledged to audit the managed care organizations to determine whether they lowered health care costs for those patients. However, the state failed to conduct any audit on that program according to Generally Accepted Accounting Principles, and in fact never has. With no cost-effectiveness verification, the state has enrolled more people in managed care Medical Assistance. Wouldn’t the managed care organizations, if they produced savings compared to the old system, demand audits as validation of their superior operations? They have instead consistently blocked independent scrutiny.
HCMC operates alongside the county’s own managed care organization, Hennepin Healthcare. The HCMC spokeswoman explained that HCMC told the powerful senator, who possessed final control on which health care bills would be eligible for the enactment-determining vote, that HCMC would lose too much money if the Legislature passed this bill. Essentially, HCMC wanted to keep Medical Assistance patients corralled in managed care organizations because the managed care status of those patients allowed HCMC to obtain more federal dollars under the federal 340B drug discount program. HCMC feared that if given the freedom to leave managed care, large numbers of Medical Assistance patients would do so, depriving HCMC from using those patients to claim the large drug money rebates available in the federal discount program. The senator eliminated our justice bill.
Rep. Kim Hicks of Rochester, author of our 2023 justice bill, characterized managed care as a product the state government buys to provide health care for low-income patients who cannot afford it on their own. The question we at Health Policy Advocates ask is, if the managed care product is so superior—as managed care organizations have repeatedly claimed over the decades—why does state government compel the majority of Medical Assistance patients into it? Wouldn’t they automatically, enthusiastically choose it? Why would managed care organizations have any fear that those patients might abandon their product if it satisfied patient needs?
In July, the federal government published a report (Office of Inspector General # OEI-09-19-00350) that shows managed care frequently denies treatments to Medical Assistance patients that are actually medically necessary. And the patients who got the most denials of care were patients of color. In light of that report’s findings of fact, passing the Medical Assistance Freedom to Choose bill has become ethically urgent. In the upcoming legislative session, which legislators will side with HCMC’s decision to deprive Medical Assistance patients of their freedom because it is necessary for the well-being of the bottom line of health care corporations?
It is comforting to think our democracy still provides for citizens to call upon their two legislators, ask questions, and declare policy preferences for passage of SF404/HF816, the Medical Assistance Freedom to Choose bill.

The authors are longtime members of Health Policy Advocates.


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