The House Health Committee is scheduled to consider HB 655, Health Care for Working Families, tomorrow morning.

First, kudos to the leadership for bringing this issue forward and to members for participating in the discussion.  The governor is strongly in favor of Medicaid expansion. Many progressive House and Senate members have expressed support for Medicaid expansion, while most Republicans have opposed it.  Polls have been mixed. It is an important issue and one that should have a hearing and robust discussion.  Our legislature represents citizens across the state with diverse backgrounds, experiences and expectations.  More issues should be discussed, not fewer, and elected officials should be responsible and held accountable for their positions on important policy ideas. Constituents should know where their lawmakers stand on issues.  The more and varied the issues, the more robust the discussion, the more transparency in the debate, the better.

The problem being addressed is many North Carolinians cannot afford health insurance because the cost of health care is too expensive.  There are two directions to go: accept the high cost of care and force taxpayers to bear more of those costs, while limiting their options, or lower the cost of health care so people can purchase insurance that is affordable and best meets their needs and those of their family.  It’s really that simple.

The John Locke Foundation has written extensively on the problems with expanding Medicaid and there are many.

  1. The added costs are enormous; $6 billion over the first two years.  Medicaid expansion would increase the state’s total Medicaid budget by 27% and boost total state spending by 7.4% in FY 20-21.
  2. Medicaid is intended for low income pregnant women, children, blind, disabled and elderly people.  Over 2 million NCians are currently on Medicaid, half the babies in NC are born under Medicaid coverage.  Expansion would add at least 500,000 additional people to the system; over 70% are able bodied, working age, childless adults.
  3. Current Medicaid patients are in desperate need of support services that they qualify for but have not received. About 12,000 current Medicaid recipients are on waiting lists — some five to 10 years long — to receive support services, the ninth-highest in the country. These services are for people struggling with mental illnesses or severely disabled children. We need to take care of them first.
  4. In studies from states that have expanded Medicaid, expansion has led to an increase in emergency department visits.
  5. Fewer doctors are accepting Medicaid patients because of lower reimbursement rates.  Adding 500,000 more patients mean less access to an already diminishing pool of providers. Health insurance is worthless if you can’t access care.
  6. In states that have expanded Medicaid, a large number of individuals drop private insurance and enroll in “free” public insurance, employers drop private coverage for their employees to join Medicaid under expansion and thousands of uninsured individuals are already eligible for a subsidized plan under the ACA.
  7. State Auditor Beth Wood has found program overruns of $275 million, hundreds of millions of dollars in managed care provider overpayments and nationally Medicaid made $36.7 billion in improper payments in 2017. Throwing more taxpayer money into a fiscally problematic program is not a sensible plan.
  8. North Carolina Medicaid is in the middle of a transformation to managed care under a waiver granted by the federal Department of Health and Human Services.  The managed care program will roll out in a number of phases over the coming years and we need to make sure we get it right. For patients, providers, insurers and taxpayers.  Let’s make sure we get it right before adding hundreds of thousands of new enrollees.

Rather than accepting the high cost of health care that is driving affordability of health insurance out of reach of many NC citizens, looking for ways to lower those costs in a sustainable manner, make insurance plans affordable and empowering all North Carolinians to choose the plan that works best for them and their families is the better plan.

The John Locke Foundation offers numerous ways to bring down the costs of healthcare while focusing on market driven, patient directed solutions.

  1. Repeal Certificate-of-Need laws.
  2. Encourage the use of telemedicine.
  3. Expand the scope of practice for providers, allowing them to offer services they’ve been trained to provide.
  4. Amend supervisory requirements to allow experienced practitioners to provide care where appropriate.
  5. Introduce dental therapy as a way to extend dental care cost effectively.
  6. Encourage direct primary care practices to continue to grow and flourish.
  7. Allow and expand small business health plans to offer more flexibility and customization of health insurance plans.
  8. Adopt a rule, as is being considered by the Trump administration, to require doctors and hospitals to disclose the rates they negotiate with insurance companies.
  9. Establish a foundation to offer grants or low-interest loans for expansion of medical services, assistance with medical training costs, and housing and personal needs for mid-level providers in rural areas. Use a percentage of hospital nonprofit property, income and sales tax relief to fund the foundation. Allow other businesses or philanthropies to contribute to the fund.
  10. Lead the nation and region by establishing a Southeast compact to offer health insurance plans across state lines.
  11. Encourage competition, discourage monopolies and market consolidation in the hospital, insurance and pharmaceutical industries.

North Carolina, rather than following the pack down a dangerous path, can avoid mistakes and problems states that have expanded Medicaid are experiencing and be a leader in addressing the real problem in a patient driven, individual choice and sustainable way.