DOCTOR'S VIEWS ARCHIVE

HMOs Desert The Poor And Elderly


by Frederick Hecht, M.D.

(July 6, 1998) From 1992 to 1995 I worked in France. There 80% of our health care costs were paid for by the Social Security program. Yes, by the government.

The United States has generally avoided this "scary spectre of socialized medicine." Instead of dealing with the faceless government, we deal with equally faceless health care companies.

In this connection, The New York Times led off its front page today with a report by Peter T. Kilborn on the retreat of some of the nation's largest health maintenance organizations (HMOs) from the care of the poor and the elderly.

Prominent HMOs such as Pacificare, Prudential, Kaiser Permanente, Aetna U.S. Healthcare, Oxford Health Plans, and Blue Cross and Blue Shield have quit Medicare and Medicaid coverage in many different markets.

The factors cited by the HMOs include cuts in government payments. The bottom line is general operating losses. Even companies dedicated to providing health care do not like to see losses on their balance sheets.

The HMO retreat from Medicaid (the U.S. care program for the poor and disabled) has been far more pronounced than that from Medicare (the program for senior citizens). The retreat from Medicare has been mainly confined to rural communities with few patients where clinics and doctors are scarce.

Most of the HMO withdrawals from Medicaid have occurred in populous states with large pockets of urban poverty. Half of the 32 million Medicaid recipients are currently in managed health care programs. Hence, at least 16 million people, most of them among the urban poor, are affected by the HMOs cutting loose Medicaid clients.

The Medicaid clients who are shed by HMOs have a few options:

  • They can search for individual doctors willing to treat them for Medicaid fees.
  • They can look (as do the poor in the slums of Bombay) for charity health care.
  • They can go to emergency rooms or to HMOs that accept Medicaid clients.