You should read our earlier post about Rep. Nelson Dollar’s excellent objections to Medicaid reform. Dollar deserves kudos for pointing out that our system is not broken.

Despite these objections the legislature is charging ahead. If we want reform, however, the state needs to expand Medicaid at the same time. Why? Because to reform Medicaid we need permission from the federal government. According to the bill passed by the General Assembly we will officially seek this permission from the federal government by June of 2016. The Obama Administration is unlikely to make privatizing our Medicaid program a major priority in its last few months of office. That is not the sort of legacy he is interested in leaving.

If we do not get approval from the current leadership at Health & Human Services then North Carolina will need to wait until a new President takes office. Then the new President will have to nominate an HHS Secretary and we will have to wait for the Secretary to be confirmed. At some point after that HHS will begin to review our reform proposal.

Alternatively, North Carolina could include expansion in the reform plan. Then the Obama Administration would act quickly to approve our waiver. Certainly HHS is not excited about dismantling our model Medicaid system, but they could live with legislative changes if it meant covering 500,000 more people in our state.

With expansion reform will move quickly and our proposed changes will be accepted by HHS. Without expansion reform will be a long, long road to an uncertain destination.


This morning’s lead editorial in the Winston-Salem Journal calls on state legislators to slow down with the last-minute. end-of-session sausage making when it comes to selling off the state’s Medicaid program. The Journal rightfully describes the sell-off as a “huge and controversial deal” that deserves much more public input before moving ahead.

An editorial in Raleigh’s News & Observer over the weekend was even more pointed:

“GOP lawmakers want to install a managed care system in which Medicaid would be put under a new division in state government and come under the control of three contracted companies offering managed care plans. Groups of doctors and hospitals would enroll people in regional managed care networks. And Medicaid no longer would pay for each hospital visit or medical procedure for the 1.8 million enrolled in North Carolina. The companies would get a fee for each patient at the time of enrollment. If the cost of care ran over the fee, the companies would be liable.

In other words, it’s money first, people second.

This is a terrible idea. First, as has happened in other states that have tried this system, companies that find they can’t make money leave. Bob Seligson, CEO of the state Medical Society, notes that expenses also can go up. Hospitals and doctors have fought this very bad notion for years, and they’re the ones on the ground providing care….

Once again, Republican legislators move to fix something that’s not broken, even when their decisions could put the health of their constituents in peril.”

Let’s hope lawmakers make the unusual move of coming to their senses before taking this destructive step.


MedicaidThe endless 2015 legislative session appears, mercifully, to be nearing a conclusion after nine long months. With the passage of the budget early this morning, legislators are now free to wrap up final details and adjourn for the year. Unfortunately, one of those final details will be giving away the state’s award winning Medicaid program to giant, for-profit insurance companies. As Lynn Bonner reports this morning in Raleigh’s News & Observer:

“Legislators have agreed to privatize North Carolina’s $15 billion Medicaid program, a change that doctors and hospitals have been fighting for months, but which some Republican legislators have championed as a remedy for unpredictable spending.

Under House bill 372, three insurers would be given contracts to offer statewide Medicaid managed care plans. The state would have up to 10 contracts with “provider-led entities,” or groups of doctors and hospitals, that would enroll patients in regional managed care networks.

Rather than pay for each hospital visit or medical procedure as it does now, Medicaid would give the companies a fee for each patient when they enroll. The government would not be liable for cost overruns.”

In many ways. of course, this is a perfectly apt conclusion to the session. The 2015 session opened nine long months ago with one obvious and overriding imperative: North Carolina needed to follow the lead of 30 other states and expand Medicaid under the Affordable Care Act. Such an act would have saved thousands of lives per year, pumped billions of dollars into the state’s economy and strengthened an already highly effective program. The state’s feckless governor admitted these facts at times even as he manufactured excuses not to act.

Now, however, the decision has been made to, essentially, do the opposite. Rather than expanding the program to save lives, state leaders will heed the siren song of fat cat corporate lobbyists and give away this enormously valuable public asset to a handful of giant corporations that will, in turn, squeeze profits out of it by denying services to people in need.

The bottom line: More poor people will die, our economy will suffer unnecessarily and wealthy, out-of-state corporations will pad their profits. It’s hard to think of a concluding act that better symbolizes the awful 2015 session.

Commentary, Uncategorized

The North Carolina Justice Center launched radio and digital ads this week urging people to ask Gov. Pat McCrory to release a plan that expands affordable health insurance in our state.

We have the opportunity to tap federal funds to extend affordable insurance coverage to more than 500,000 people struggling to pay for care. Our tax dollars are sitting in Washington waiting to be used to boost rural health care in our state and save more than 1,000 lives every year.

We can expand Medicaid with this money or we can develop a state-specific plan to experiment with new coverage ideas. Conservative Governors in Arkansas, Iowa, Indiana, Montana, Utah, Tennessee and elsewhere have proposed specific policies. Gov. McCrory told news outlets at the beginning of the year that he was considering doing the same. The hold up, he claimed at the time, was the latest Affordable Care Act challenge at the U.S. Supreme Court. He would announce his support, or opposition, to expanding coverage after the high court ruled in King v. Burwell.

King v. Burwell came and went and still no word from the Governor.

The Governor and legislators all have access to taxpayer funded healthcare so they can afford to delay a decision. Many others in our state aren’t so lucky.

These 500,000 North Carolinians are mostly the working poor with jobs in construction and food service that do not provide health insurance benefits. They don’t currently qualify for Medicaid because eligibility is restrictive in our state. They can’t afford to buy private insurance. Now they are stuck and just need action from their elected representatives.

It starts with the Governor. He can change the dynamic by showing leadership and proposing a plan. Go to NC Left Me Out and share your story if you or a loved one are in the coverage gap. And then use the phone number listed to contact Gov. McCrory and ask him, “Where’s the plan to expand coverage?” We can’t wait any longer.


Today’s Fayetteville Observer hits the nail on the head with this editorial condemning the state Senate’s plan to turn North Carolina’s Medicaid program over to giant, for-profit insurance corporations:

“The N.C. Senate’s drive to restructure the Medicaid program is making less sense all the time.

We understand lawmakers sometimes succumb to the urge to fix what’s not broken. But when they, and the voters, see mayhem coming, they usually back away.

We hope that’s happening this week, as members of the General Assembly get more evidence that our Medicaid management model is anything but broken.

According to just-released long-term review by the State Auditor’s office, the agency that administers the Medicaid program here is saving taxpayers a bundle – and providing improved medical outcomes at the same time.

The audit measured results achieved by Community Care of North Carolina from 2003 through 2012. The physician-led program has won national acclaim for its effectiveness in running the health-insurance program for the poor and disabled. Other states are copying the system, which has produced budget surpluses for the past two fiscal years.

Medicaid, funded jointly by the state and federal governments, covers about 1.4 million North Carolina residents. According to the audit, Community Care succeeded in managing medical conditions and keeping patients out of the hospital. That resulted in savings of about $78 per user per quarter, which adds up to saving state and federal taxpayers something approaching half a billion dollars a year.

Most lawmakers would likely agree that we’re talking real money there, yet the drive for privatization still has its hooks in the Senate, our legislative branch most driven by ideologues. Read More