I’m writing as a curious citizen. The ideas presented are my own musings. They do not represent the beliefs of my employer or any other entity with whom I may be associated. I solely own these curious ideas.
Over the past several weeks Passport Health has made a series of troublesome announcements. The first heralded Passport’s insolvency by Summer 2019. The second announcement proclaimed a lawsuit against the State of Kentucky. Finally, the most troubling edict was the indefinite postponement of work of Passport’s new headquarters in Louisville’s West End. Why has Passport Health - a seemingly successful company, an anchor in Louisville - felt the need to share such devastating news? The cause is rooted in a Kentucky State government decision to adjust regional Medicaid reimbursement rates. Out of all the region’s in Kentucky, the region with the largest population was the only region to face a 4% decrease while all other regions received close to a 2% increase. Five managed care organizations handle all of Kentucky’s Medicaid claims. Four of those are private institutions. Private institutions are owned by individuals or stakeholders who share the institution’s profits. The “Big 4” are undergirded by the premiums individuals and employers pay for market-rate health insurance. I assume the revenues from these premiums far outweigh their earnings from Medicaid reimbursements. Passport Health Care is the state’s only nonprofit Medicaid provider. Their business only exists to provide health care to about 310,000 people with low income and disabilities living primarily in Jefferson County. Passport’s business model relies on Medicaid reimbursement. Passport was created in 1997 as an experiment to control the high cost of health care in Jefferson County and its 15 surrounding counties. In fact, they are the only managed care organization handling Medicaid claims in this region of Kentucky. The four commercial organizations divide the Medicaid claims for the rest of Kentucky. Kentucky has nearly 1.4 million Medicaid recipients and Passport’s 310,000 clients make it the state’s second largest Medicaid provider. There is definitely a demand for Medicaid in this region, but no other managed care organization chooses to operate in this region. I find it curious that the region where the only managed care organization choosing to serve the area was negatively impacted by the changes in Medicaid reimbursement rates. It seems to me Kentucky’s elected officials would want to encourage and support an entity already operating in a seemingly challenging region. It’s even more curious that a nonprofit organization had to be created to provide for the healthcare needs of people with low income and disabilities in Jefferson County. All five of Kentucky’s managed care organizations chose Jefferson County to locate their headquarters, but Passport was the only one who chose to serve its people for nearly two decades. What is it about this region that makes it so undesirable for managed care organizations? The primary Social Determinants of health are economic stability, neighborhood and physical environment, education, food, community and social context, and health care systems. Mathematically Jefferson County’s population only increases the probability of more of its residents experiencing challenges associated with these social determinants. Jefferson County also has the state’s largest concentration of black and brown residents. These citizens have been overwhelmingly impacted by Kentucky’s historically discriminatory and racist practices systematically denying or limiting their access to the social determinants of health. Only one managed care organization has chosen to assist this population by providing access to affordable health care. Passport was founded as an experiment to reduce health care cost. Did Passport raise the ire of Kentucky’s political leaders when they chose to impact health care cost by positively influencing the economic opportunities for black people in a historically disinvested community? Is Passport’s choice to invest $130 million of their earnings in Louisville’s West End to begin addressing the root causes preventing positive access to the social determinants of health related to the significant decrease in the region’s reimbursement rate? Unlike the “Big 4”, Passport’s nonprofit earnings are not shared with private individuals or stockholders. By definition, the earnings of a nonprofit entity must be reinvested in operations or the community it serves. Choosing to relocate their corporate headquarters from a flourishing suburb to a historically disinvested and underinvested neighborhood was unprecedented. During 2018, I served on Louisville’s Planning Commission, which makes recommendations to the Louisville Metro Council regarding land development. I heard testimony from Passport’s CEO, Mark Carter, stating Passport’s desire to relocate their headquarters where they could best benefit their clients. The majority of their Medicaid clients lived in areas near the site of the proposed new headquarters. Passport found that many people applying for their living wage hourly jobs lived near the proposed site. Passport believed investing in the community could spark additional investment. They saw their investment as a way to significantly increase opportunities for the families they served while positively impacting the social determinants of health. Passport proposed to work with existing West End neighborhoods to plan a development where Passport employees and the surrounding neighbors would feel welcome, safe, and included. As a member of the Planning Commission, I voted in favor of recommending approval for the Passport development. I believe Passport’s decision to initiate a process of equitable redistribution of resources made some people uncomfortable. As a curious citizen, I watch, listen and question. I’m an advocate for redevelopment in Louisville’s West End and all other neighborhoods where entire groups of people are excluded from opportunities to choose what is best for their lives. Wealth creation improves people's ability to make choices. Passport Health intentionally chose to use its profits to ignite wealth creation in a black community. One curiosity I noticed while serving on the Planning Commission is that people with significant wealth and influence will go extraordinary lengths to maintain their real or perceived status. My curiosity makes me wonder if that is what is happening to Passport right now. Is there some unknown individual or entity who believes Passport’s investment in the West End will disrupt the status quo? Is this silent puppet master working the strings of Kentucky’s elected officials to bring ruin to Passport simply to impede wealth creation in communities populated by black people? Was there some fearful Passport employee unwilling to work in the West End who called friends in high places to stop Passport from making a “tragic” decision? To some, my curiosity may sound like the beginnings of a conspiracy theory. However, over 400 years of history, blockading wealth creation for black people in America gives credence to these questions. Kentucky’s political leaders have made intentional decisions in the past to halt the equitable distribution of wealth to all its citizens. Is a Medicaid reimbursement rate that negatively impacts only one of five managed care organizations an orchestrated oddity designed to limit wealth creation? Is this a current day example of “redlining”? Will people who can speak-up and stand-up against such intentional manipulation of systems be silent once more as hundreds of thousands of Kentuckians are denied access to opportunity?
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AuthorRamona Dallum Lindsey is an artist, speaker and curious citizen who finds strength in the wisdom of her elders. Archives
February 2019
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