The NC General Assembly opened for business just yesterday, and the calls are already out for cutting deeply into state services to overcome multi-billion dollar budget deficits. In health care, all options are on the table – freezing child health insurance, cutting rates we pay doctors, and even reducing things as minor as fluoride rinse programs.
Expanding – not cutting — health coverage options to families who are losing their jobs by the tens of thousands is what we should be doing in an economic downturn. Most people who lose their job lose their health coverage too – and if a family member gets sick without insurance that quickly gets expensive. A looming threat of bankruptcy because of medical bills isn’t something NC families need right now.
For state lawmakers willing to think outside the box there is opportunity in this budget crisis however. What’s notably not on the table instead of these ill-advised cuts are four options that could improve quality of care while saving millions of taxpayer dollars. Unfortunately, powerful special interests who benefit from keeping our health system in its current form oppose these changes. Even so, common sense dictates that before we cut health care for kids or people with disabilities we consider the following:
1. Create a Model Preferred Drug List for NC’s Medicaid, State Health Plan, and Workers Comp programs.
North Carolina already is in the group of states with the highest percentage of their Medicaid budgets going to pay for prescription drugs. We could drastically cut these expenditures by following the lead of states like Washington where they are saving $25 million a year with a model prescription drug program. A respected committee of physicians and other professionals works with regional academic centers and others (like Consumer Reports magazine at www.crbestbuydrugs.org) to create a list of the most effective – and most cost-effective drugs. Then the same list of drugs is available to everyone in the state getting health insurance through the state – and a discount program has even been created for people without state health coverage. North Carolina already has a effort at controlling drug costs – the Prescription Advantage List – however this is a woefully inadequate program that has been hamstrung by powerful pharmaceutical industry opposition.
2. Stop Paying for Poor-Quality Care.
The federal Medicare program just did this. When care is delivered that is either clearly harmful or a result of mistakes by the provider, we shouldn’t pay for it. A hospital-acquired infection that results from lack of proper use of antibiotics should be treated with the cost covered by the hospital and not by taxpayers. Medicare estimates a $21 billion savings in its hospital budget – which would mean millions in savings here if Medicaid implemented this rule.
3. Expand Community Care of North Carolina.
NC has been trying to do this for a while. Our award-winning program for kids and parents in Medicaid has already been determined by independent analysts to save around $160 million a year. Transporting the techniques of giving patients a medical home, listening to their needs, and helping primary care offices have the resources to do more for patients than just a ten-minute office visit have translated into major savings and a major boost in quality of care. It all boils down to parents having a doctor they know and trust – and that’s priceless as anyone who has had children knows. Expanding this Medicaid effort to older North Carolinians and people with disabilities will mean more cost savings and better quality care.
4. For long-term health savings establish a NC Institute for Health Care Quality, Cost, and Research as a collaborative effort between the state and major public and private universities. Collecting research on what works – and what doesn’t – in health care, we could start paying for care that’s necessary and not the estimated 1/3rd of unnecessary health services, drugs and procedures delivered in the United States every year.