Second chance
Published October 15, 2014
Editorial by Greensboro News-Record, October 15, 2014.
North Carolina passed up a good deal in 2013, but it can regain a lost opportunity.
When Gov. Pat McCrory and the state legislature said no to Medicaid expansion under the Affordable Care Act, they not only cost 300,000 to 500,000 residents a chance to receive reliable medical coverage. They also passed up billions of federal dollars that would have supported hospitals and other medical providers. That money now is being spent in other states, helping their economies.
At the time, McCrory said the state’s Medicaid system was “broken” and could not enroll more patients. Actually, there was evidence it was pretty well managed, although implementation of a new computer claims-processing system was a disaster. At any rate, improvements have been made, and the state’s Department of Health and Human Services recently announced it finished the last fiscal year with a $63 billion Medicaid surplus. That’s good news.
It gives the department an opportunity to consider Medicaid expansion after all, Secretary Aldona Wos told The Charlotte Observer last week. All that’s required is to work out some flexibility with the federal government, she added.
“We really are evaluating the different options and will be presenting them to the governor. But the road to the end result is a rather long road.”
It may be. It involves negotiating with the U.S. Department of Health and Human Services, agreeing to a plan, getting the governor’s OK and, finally, convincing the legislature. That is a long road that finishes with a steep, uphill climb. But it’s worth the effort.
Wos’ interest in “evaluating the different options” presents a chance for Sen. Kay Hagan to act as a broker between her fellow Greensboro resident and the federal health and human services secretary, Sylvia Burwell. Hagan has criticized the state’s decision to forgo expansion. Perhaps she can help find a remedy.
In August, Pennsylvania’s Republican governor, Tom Corbett, reached an agreement with HHS to expand Medicaid coverage through managed-care organizations. Recipients will pay premiums of as much as 2 percent of income but can earn discounts for healthy behaviors.
Indiana’s Republican governor, Mike Pence, calls his proposed expansion plan “Medicaid reform.” It uses health savings accounts and contributions by participants but is largely funded with Medicaid dollars. HHS has yet to sign off.
In North Carolina, Wos could fashion a way forward similar to the Medicaid reform plan already proposed to the legislature but not adopted. It would use accountable care organizations to provide comprehensive care and control costs. The model would work just as well for an expanded pool of patients.
The goal should be to improve health care for North Carolina residents who can’t afford it, keeping them from relying unnecessarily on emergency rooms and inpatient services, which are costly and sometimes too late.
North Carolina may come late to Medicaid expansion, but that’s better than never.
