ON Oct. 11, 2010, Moise Brutus was in a motorcycle accident. He awoke from a coma three days later as a triple amputee, having lost both legs and his left hand.
In many ways that nightmare scenario was made worse by what followed when Brutus experienced life in the traditional Medicaid system.
“It was really tough,” Brutus said. “At one point, I remember thinking, ‘I can't believe I'm in the United States.' Because it felt like I was getting Third World country care.”
His mother often had to change his bandages. At one point, a bone jutted out of his leg, but he was sent home from the emergency room without treatment. The prosthetics that Medicaid provided kept breaking — at a taxpayer cost of $25,000 to $30,000 apiece — while rehabilitation centers accepting Medicaid couldn't serve a triple-amputee. Brutus fell into deep clinical depression; his weight dropped to 76 pounds.
Fortunately for Brutus, his home state of Florida embarked on a Medicaid reform. It lets private insurance plans compete to provide managed care for Medicaid patients. Customized patient benefits replaced a one-size-fits-all approach. The reform included incentives for providers to take the most challenging patients. It rewarded providers based on health improvement. Florida Medicaid patients soon had a choice of up to 11 private plans.
Brutus was among those benefiting from the pilot project. The difference was dramatic: Coverage provided through privately managed Medicaid plans paid to repair his leg stump. He got prostheses costing around $60,000 apiece — but those were one-time expenses because the prosthetics didn't break. He was sent to a quality rehab facility, where he learned not only to walk again but to ride a bike. He's now a competitive cyclist biking 100 miles per week. And his coverage connected Brutus with support groups helping address the mental health challenges he faced.
Today Brutus is nearing college graduation with a degree in chemistry. He expects to soon be a gainfully employed, taxpaying citizen who leaves Medicaid support behind.
Oklahoma officials are being pressured to expand Medicaid as a result of Obamacare. A better option would be to focus on making Medicaid work for those already in the existing program by pursuing Florida-style reforms here. These reforms would not only benefit patients like Brutus, but would save taxpayer money.
Once expanded statewide, Florida's reform is expected to save $1 billion per year; a similar effort in Louisiana is estimated to save $159 million in its first year. In Kansas, similar reforms are projected to save $1.1 billion over five years — all without reducing patient care and, in many cases, improving it.
House Bill 1552, by Rep. Mark McCullough, R-Sapulpa, and Sen. A.J. Griffin, R-Guthrie, would enact Florida-style reforms in Oklahoma. The bill appears stalled this year. Lawmakers should make it a priority next session. The growing cost of the existing Oklahoma Medicaid program is already diverting money from schools, roads and public safety, so the potential taxpayer savings alone should appeal to lawmakers.
But most of all, it could mean far better outcomes for those the program is supposed to serve. As Brutus notes, “There's really millions of other people just like me out there.”