If It Isn’t Broken, Don’t Fix It

nurse and babyMost people think of Medicaid as health insurance for the poor. That’s not exactly accurate.

Each state creates its own criteria for Medicaid coverage. In North Carolina, more than half of the 1.8 million people on Medicaid are children from poor families.

Some 490,000 are elderly or disabled. These are also the most expensive recipients – according to the Kaiser Family Foundation, 63% of North Carolina’s Medicaid expenditures go to providing care for these two groups.

That leaves about 309,000 adults who received Medicaid coverage. These are extremely poor parents of children who receive Medicaid and pregnant women. Just being poor and uninsured will not get you Medicaid coverage in North Carolina.

Fortunately, North Carolina has one of the best-run and most cost-efficient Medicaid programs in the country. This is thanks to Community Care of North Carolina, a nonprofit “physician-driven, patient-centered managed-care organization”  that is credited with saving Medicaid nearly $1.5 billion in 2007, 2008 and 2009 through its management system. In fact, just last month, Senator Richard Burr presented CCNC with an award from the Healthcare Leadership Council, a national group of health care CEOs, for its excellent work.

So it’s understandable that there’s a lot of concern about Governor Pat McCrory’s plan to privatize Medicaid in North Carolina. Leaders from the NC Medical Society and the NC Pediatric Society,  as well as numerous individual physicians and health-care advocates, have said they think it’s a bad idea.

So far, the governor and Aldona Wos, the head of the NC Department of Health and Human Services, have failed to articulate a clear plan for what privatization means. In fact, a recent series of events on the subject just added to the confusion and worry.

What is clear is that privatization puts profits ahead of patient care. As Dr. Jo Ellen Hirsch of Fayetteville explains in a recent op-ed in the Fayetteville Observer:

Private insurers are obligated and responsible to shareholders, not to the citizens of North Carolina. Large out-of-state managed-care companies would funnel dollars away from our state. States that have gone this route have seen persistently higher costs, poorer access to care, and late payments to hospitals and doctors…

Kentucky contracted with three managed-care companies in 2011 and experienced late payments, resulting in hospitals laying off employees, depleting reserves and defaulting on bonds. Outsourcing of Medicaid management has also failed miserably in Connecticut, Alabama and Idaho. These states, along with Colorado and Oklahoma, are now looking to North Carolina’s successful model as they move toward implementing new systems.

North Carolina should be patting itself on the back for its ingenuity and forward-thinking, not putting profits before patients, and the poor.




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