Already, three quarters of Medicaid beneficiaries who receive only medical care (mostly low-income mothers and their kids) are in managed care plans.
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The issue of quality has become paramount as more Americans join managed care plans which aim to control costs by limiting access to specialty care.
The core of the Republican Medicare cost-reduction bill is Medicare Plus, a plan offering seniors a range of managed care plans, or HMO's, from which to choose.
Officials there are working with the Obama administration on a plan that would expand coverage for low-income residents by channeling them not into Medicaid, but into private managed care plans.
Health care also cited in many polls as a key issue for Americans in the 2000 elections, and Clinton will likely press Congress to pass the so-called patient's bill of rights, which would give patients some new powers in dealing with their health maintenance organizations (HMO) and other managed care plans.
Mothers in managed-care plans are only two-thirds as likely to be subjected to a Caesarean.
Of the public sector's Medicare recipients, meaning most Americans over 65, 16% are enrolled in managed-care plans.
Marketing managed-care plans to the elderly is expensive, since they must be persuaded and enrolled one by one.
But with over 75% of America's privately insured employees already in managed-care plans, there are few corporate pickings left.
After more than a decade, managed-care plans--with their incentives for doctors to hold down treatment costs--cover about half the population.
But HMO foes do think they can make the managed-care plans behave better, by methods as varied as the opponents themselves.
And since Aetna specializes in selling managed-care plans to businesses, not government, it's not vulnerable to the coming cost squeeze on Medicaid.
Only 16% of these people are currently enrolled in private managed-care plans, and the federal government is keen to double this proportion by 2002.
It also provides subsidies to private insurers to compete with traditional Medicare, giving seniors the opportunity to join managed-care plans, which typically cut costs by restricting patient access to specialists.
Basically, what HHS states in its memo is that its deal with Arkansas is not that different from its traditional endorsement of the use of private managed-care plans to administer the Medicaid benefit.
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With managed care and preferred provider plans, benefits for this out-of-network care may be limited, but your annual out-of-pocket cap should still apply.
But the average pharmacy ekes out a 2% profit on prescriptions, and those profits are being squeezed further as health plans and managed care organizations demand ever-deeper discounts.
In one of these, salaried workers and the self-employed have to contribute 12% of their earnings to health plans run by managed-care organisations similar to those in the United States.
"We have a situation where pollsters, consultants, and any other individual in the political arena has basically sent a message to their candidates, 'Run against managed care, '" says Karen Ignagni of the American Association of Health Plans.
After the backlash against managed care, it is now seeking to delegate more responsibility to individual consumers, mainly through plans with more cost-sharing by way of higher co-payments.
Those restrictions have eroded in the era of managed care, however, as doctors increasingly must answer not only to patients but insurers and government health plans.
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