Expanding Medicaid makes economic sense

EDITOR’S NOTE: Robert Bilbro is a retired Raleigh internist and cardiologist who has served as president of the medical staff at WakeMed and president of the Wake County Medical Society.

 The total expenditures for healthcare in North Carolina would be strongly decreased if access to primary care were provided to all citizens. For persons established with a primary physician as a medical home, costs of healthcare are 33% less than for people without such a relationship.

Currently there are over 600,000 people in our state who lack health insurance and do not have dependable access to a doctor other than through hospital emergency departments.  For economic reasons alone, logic demands that North Carolina expand Medicaid coverage.

It is clinically well proven that management of chronic health problems such as high blood pressure, diabetes, and elevated cholesterol is highly effective in decreasing the risk of a patient’s health deteriorating and developing major complications. Persons with no health insurance, with occasional exception from physicians’ benevolence, get their healthcare through emergency departments (ED) which are not workable for managing chronic problems.

Likewise, behavioral healthcare cannot be managed through the ED. Disabling problems of schizophrenia and bipolar disorders can be effectively controlled with medications if they are properly managed through continuing care.  Access to counseling is very helpful for persons with mental health problems.  The current epidemic of substance abuse disorder is helped even if not eliminated by a relationship with a primary care physician.  
  
 Uninsured patients generate excessive cost from ED visits and greater need for hospitalizations. In NC the average primary care office visit costs $100-$150, ED visits cost an average of about $1600 and the expense for hospitalizations averages nearly $15,000, but may exceed hundreds thousands of dollars.

Payment for these excessive expenses involves:
a) Cost shifting for insured patients resulting in higher premiums for commercial insurance,
b) Subsidies with local tax dollars,
c) Deficits for smaller hospitals, and
d) Altruistic generosity by physicians and surgeons.

The outlay of dollars would be significantly less if these uninsured patients had access to primary care and a medical home rather than making so many trips to the hospital.

To make Medicaid coverage available to hundreds of thousands of North Carolina citizens would save overall costs in N.C. with little increase in state tax dollars. It would result in less economic hardship for smaller hospitals and generate tens of thousands of jobs.

Recently the federal government has increased the economic incentives for states which expand Medicaid. Thirty-eight states have done so with North Carolina forfeiting about $29 billion dollars since 2010 in federal subsidies.  Yet, NC taxpayers are helping to pay for healthcare in those other states.

Hospitals are required to provide medical care to uninsured patients who enter their doors. This economic burden is especially heavy in rural areas of our state which have a greater percentage of uninsured people than in urban areas.

Since 2005, eleven rural hospitals in North Carolina have closed. Many others have been assimilated into large hospital systems. This consolidation has increased medical costs and decreased local control. The urban/rural divide in our state would be diminished if Medicaid were expanded.

The most common​ cause of individual bankruptcy is having health problems with no health insurance. For the North Carolina legislature to move forward with increasing availability of Medicaid would be a very significant and immediate enhancement for the economy of our state and for more than a half million individuals.