RALEIGH — The sixth anniversary of the federal Affordable Care Act offers N.C. policymakers a chance to reflect on changes that could help improve health care in this state. That’s according to the John Locke Foundation’s health care expert.
The ACA, also known as Obamacare, heads back to the U.S. Supreme Court again on Wednesday, March 23, exactly six years after President Obama signed the measure into law.
Meanwhile, Katherine Restrepo, JLF health and human services policy analyst, is focusing on state-level policies that could help North Carolina cope with challenges linked to the troubled federal law. “It’s a rare occasion when policymakers have full authority over health care decision-making at the state level,” Restrepo said. “As the N.C. General Assembly prepares to begin its short legislative session in late April, lawmakers should consider several important policy changes.”
At the top of Restrepo’s list: Repeal the state’s certificate-of-need law. “North Carolina requires your doctor or hospital to request and receive a government permission slip before offering you new technology, better facilities, or more treatment options,” she explained. “In 1987 the federal government repealed its CON mandate, and since then 16 states have ended state-based CON laws. However, North Carolina still allows bureaucrats to determine your health care options.”
North Carolina’s CON program is one of the most stringent in the nation, Restrepo said. “This state regulates over 25 services that range from organ transplants to acute care hospital beds to ambulatory surgery centers,” she said. “It’s time to restore health care freedom to North Carolinians.”
Restrepo also recommends granting “full practice authority” to “mid-level providers.” “To expand access to care in rural and underserved areas, it’s critical that nurse practitioners and other mid-level providers be granted full practice authority,” she said. “In other words, the legislature should allow mid-level providers to practice to the extent they were trained when delivering patient care.”
“Under the status quo, nurse practitioners must practice under direct physician oversight when prescribing medications and ordering diagnostic tests,” Restrepo added. “Granting mid-level providers FPA will also help mitigate primary care shortages in 145 areas across the state.”
In addition to CON law repeal and full practice authority for mid-level providers, Restrepo’s third recommendation involves promotion of direct primary care.
“In exchange for an affordable monthly fee that covers a defined package of services, direct primary care guarantees patients unlimited access to their physicians,” Restrepo said. “More doctors are establishing DPC practices across North Carolina to bypass regulatory burdens that take time away from treating patients.”
While DPC faces minimal regulatory hurdles in North Carolina, it would be wise for lawmakers to take action, Restrepo said. “They should pursue legislation that simply states that direct care providers do not act as a ‘risk-bearing entity,'” she said. “This would ensure that patients’ monthly membership fees are not classified as insurance premiums.”
“Legislation that clearly defines DPC as not being an insurance product will save this health care delivery method from being subject to regulations under the N.C. Department of Insurance in the future,” Restrepo added. “Passing clarifying legislation would likely lead to a stronger DPC presence in North Carolina.”
While N.C. lawmakers can take no steps in Raleigh to repeal or replace the Affordable Care Act, they can take active steps to address its consequences, Restrepo said. “Repealing the CON law, granting full practice authority to mid-level providers, and promoting direct primary care’s market penetration in North Carolina all would produce positive results for N.C. patients.”