Commentary, COVID-19

Experts: Health pandemic exposes failure to expand Medicaid, reliance on employer-provided insurance

In case you missed it, there was a fine story on NBC News last week that highlighted North Carolina’s failure to expand Medicaid, and the huge and unnecessary problems it was causing for uninsured people even before the coronavirus pandemic.

Among other things, “Coronavirus challenges states that rejected Medicaid expansion, leaves uninsured with few options” tells the sobering story of a family physician who practices in Senate President Pro Tem Phil Berger’s district confronting the crisis.

William Luking, a doctor in rural North Carolina who runs a clinic with his brother about 25 miles north of Greensboro, said he treated one of his regular patients last week who had a dry, hacking cough and trouble breathing. The longtime patient turned scarlet when Luking said he should go to the hospital.

Amid wheezing and a severe fever, Luking’s patient said he couldn’t afford that kind of care. He didn’t have insurance.

“How many folks with this virus are going to be making the same decision?” Luking asked, noting that Medicaid expansion would have provided his patient hospital access. “That same scenario will play itself out here real quickly with folks soldiering on doing their minimum wage work while carrying the virus without seeking care. It has all the makings of a disaster.”

Luking and doctors like him have gone to great lengths to treat their patients and made personal sacrifices because, as he said, “We’re not going to fold up shop now.”

But there’s a risk that they may have to. Luking said because he will mostly have to move to doctor’s visits over the phone, he will see fewer reimbursements and payments and a greater number of uninsured patients. He’s prepared to zero-out his own salary but fears he may soon have to lay off members of his staff to keep his facility afloat.

Meanwhile, in today’s Washington Post, Prof. Jonathan Gruber of MIT lays out three steps the U.S. must take to care for the huge surge in uninsured sick people that’s coming — both as a result of the failure to expand Medicaid in states like North Carolina and the huge number of people who are becoming uninsured through job losses. Here’s the conclusion:

First, we should suspend insurance network restrictions for covid-19 patients. Patients should be able to go to the provider that is best for them, and for the community, regardless of network restrictions.

Second, this raises the problem that prices paid for care vary enormously by provider. If patients go to out-of-network hospitals with whom the insurer has not negotiated a rate, they and their insurer can face outsize bills. This is the surprise billing problem on steroids. As a result, we need an emergency regulated rate for covid-19 care that is common across providers. This would be a short-term emergency regulation. After the crisis is over, a reconciliation commission can be established to ensure that the rate was fair and reallocate if it was not.

Finally, state and federal governments should reserve money in an emergency fund to pay for covid-19 uncovered costs. Hospitals could bill this fund for treating the uninsured, as well as the cost sharing that insured patients would normally pay for their care. And once again, there could be a reconciliation after the crisis is over to ensure that insurers pay for any patients who were wrongly billed to the fund.

The United States is embroiled in a heated debate over how to fix our health-care payment system. Now is not the time to re-open that debate and try to resolve it. We need to move quickly to make sure that financial issues don’t place any unnecessary barriers in the way of effective treatment of covid-19 patients. Regardless of our views of the U.S. health-care payment system, we must all agree that its restrictions should not worsen this pandemic.

The bottom line: Thanks to our shortsighted failure to establish a national healthcare system that guarantees coverage for al, the U.S. is in a real pickle — especially in states like North Carolina. Urgent law changes are necessary to save lives and lessen the financial damage.

One Comment


  1. Jeff Leston

    March 31, 2020 at 3:20 pm

    Professor Gruber thought Americans were too stupid to understand the details of his health plan. He was also the architect of a system that allowed and encouraged $70 Billion of fraud in Medicaid annually

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