Commentary

Medicaid was not “broken” and McCrory and Wos haven’t “fixed” it

Medicaid expansionIn case you missed it over the weekend Ned Barnett of Raleigh’s News & Observer had an on-the-money column about the latest  bizarre claim from the McCrory administration that we can now expand Medicaid under the Affordable Care Act because they have “fixed” what was a “broken” system. As Barnett notes:

“It’s good news that the governor is now open to doing the right thing about Medicaid expansion. Even Tillis now says he might favor it. Refusing to do it could cost the state $51 billion in lost federal money over the next decade, according to a report from the Robert Wood Johnson Foundation.

But this change of position shouldn’t pass without a look at the rationale for not doing it in the first place. Wos’ reign at DHHS has been marked by massive provider payment problems, an exodus of staff, plummeting morale and expensive consultants hired to fill in the gaps. Now she’s saying that the administration of Medicaid has been fixed and it’s ready to take on a half-million new recipients.

If that turnaround is true, Wos has accomplished an amazing feat of introducing efficiency and accountability. Yet there’s nothing to suggest that is the case. DHHS under Wos remains an agency riddled by vacancies and burdened by a reputation for administrative dysfunction that has discouraged top applicants. But the Medicaid program itself was never “broken”. It has operated in North Carolina for decades and in recent years has successfully held down administrative costs compared with the national average. Medicaid’s “out-of-control costs,” which Republican legislators say busted the state budget, reflect wishful budgeting. Simply putting a number in the budget won’t hold down costs. People need treatment, and when there’s a recession Medicaid rolls grow. With the economy now improving, Medicaid costs are coming in under budget.”

In other words: It’s great that McCrory and Wos want to expand Medicaid and even fine if they want to delude themselves about the reasoning, but anyone who’s been paying attention knows their claims and rationales are bogus.

3 Comments


  1. Alex

    November 4, 2014 at 9:17 am

    Medicaid has always been broken. It’s a lousy insurance product with reimbursement so low that it has to be subsidized by private insurance. Throw in the heavy administrative costs and at least $20 billion in fraud each year and you have a real mess on your hands.Couple this with the lack of primary physicians willing to accept the insurance, and you end up with folks presenting at the emergency rooms just like before.

  2. Jack

    November 4, 2014 at 12:58 pm

    You have no idea what you are talking about.

  3. Alan

    November 4, 2014 at 8:52 pm

    “Always been broken”? “Heavy administrations costs”? “$20B in fraud each year”? Clueless at best…

    And of course, we all know the private health insurance industry is just SO much more efficient, and doesn’t defraud ANYONE. LOL.

    And here’s me thinking it would have been a busy day for Team Civitas and the other loons at JLF, yet some find enough time to blog about things they obviously know NOTHING about.

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