Local legislators said it is vital that, whatever measures are taken to reform Medicaid, access to quality patient care be sustained throughout the state. With a ballooning cost, a proposal to privatize the program has lawmakers split.
Something needs to be done to help the struggling program, Sen. Brent Jackson (R-Sampson) said. Rep. Larry Bell (D-Sampson) said the proposal on the table is not the answer.
A proposal was presented by Gov. Pat McCrory and N.C. Health and Human Services Secretary Aldona Wos last month that would largely privatize management of North Carolina’s $13 billion Medicaid program while keeping ultimate responsibility in state hands.
Medicaid is a health insurance program for low-income individuals and families who cannot afford health care costs. Using state and federal money, Medicaid provides health coverage for more than 1.5 million North Carolina residents — most of them poor children, older adults and the disabled — has chronically outstripped its funding. The state’s Medicaid shortfall was $418 million last year.
“It’s very important,” Jackson said of the Medicaid program. “Part of the problem is not just helping those who can’t help themselves, but there seems to be so much cost associated with it.”
Reform, whatever form it ultimately takes, is needed, the senator stressed.
“It’s a matter of trying to streamline it in some way,” Jackson remarked. “It definitely needs reforming, there’s no doubt about it. It’s a snowball going down a steep hill that can’t be stopped.”
Under McCrory’s proposal, the concept would be that three or four companies would be selected through an open bidding process. Each would set up networks of medical providers, and they would be paid a set monthly amount for each Medicaid patient enrolled, with increases for those groups that have sicker patients and for inflation.
“I don’t see how privatizing it would help,” Bell said. “I think we can handle it better the way we’ve been doing it. As it’s proposed, I don’t see any benefits to it whatsoever.”
Bell recently met with McCrory to have breakfast, a practice initiated by the governor to solicit feedback from legislators on his Medicaid reform plan.
“He didn’t seem to think it was going to be that bad,” Bell said of McCrory. “I told him I knew that doctors in Clinton were opposed to it. Even some in his party were in opposition to it. I told him I thought it would cause some of our hospitals to close. I don’t know how they can function and provide everything needed for patients.”
Indeed, in the wake of the Medicaid reform proposal, a group of nearly a dozen doctors at Clinton Medical Clinic expressed significant concerns about its impact on the local community. The plan would essentially move decision-making regarding care from local physicians to out-of-state managed care companies, trading jobs and business for less quality care, they said.
“In our opinion, North Carolina citizens deserve care directed by North Carolina physicians, not care directed by out-of state managed care company administrators,” their letter stated. “In our experience as physicians in this rural area, managed care companies do nothing to improve the quality of care, but do a lot to increase the administrative burden of practicing effective medicine.”
The letter was signed by John Thomas Newton, M.D.; J. Lawrence Rouse, III, M.D.; R. McPhail Herring, Jr., M.D.; John B. Smith, Jr., M.D.; William C. Carr, M.D.; Lawrence J. Watts, M.D.; Ken T. Yang, M.D.; Gilbert F. Palmer, V, M.D.; Ted A. Bauman, M.D.; Arthur Apolinario, M.D.; and Ada Conway, M.D.
Bell also pointed to specialized medical equipment that was purchased to be used locally. He said he did not want to see privatization come with the extreme price tag to taxpayers, not only in lost tax dollars but in less available health care opportunities.
“My concern regarding these privatization measures is that they run the risk of diverting taxpayer dollars to supplement private companies and their shareholders,” Bell said. “Whatever steps are taken, it is my hope that the administration’s plan for reform will not limit North Carolina patients’ access to health care or restrict any opportunities to generate programs that will strengthen and expand our workforce.”
Jackson said Medicaid is often the subject of multiple meetings each year, where state officials try to scrounge for money to “keep the program afloat.” The senator said he has not taken an in-depth look at McCrory’s proposal, but said Gov. Beverly Perdue’s administration attempted to wrap their hands around it to no avail, and now the current administration is trying to do the same thing.
“It’s just an overwhelmingly complicated spider monkey,” Jackson said.
Wos, a retired physician, said the managed-care operators will be “responsible for the outcomes and for managing their own risk so the taxpayer will no longer be on the hook for all of the overruns.” Managed-care companies would be required to operate statewide so they couldn’t pick healthier communities and leave the rest.
About 70 percent of the country’s Medicaid enrollees are served through managed-care systems that pay providers a monthly rate, according to the U.S. Centers for Medicare & Medicaid Services. Any changes in North Carolina will require approval from the federal government and action by the General Assembly to meet a July 2015 target for the revamped Medicaid program.
Under managed care companies, the contingent of local doctors said, necessary testing, medications and other treatments are often delayed while prior approval from the companies is sought. They noted that such endeavors “failed miserably” in other states, with other states moving toward a establishing system similar to a model built by North Carolina physicians called Community Care of North Carolina (CCNC).
McCrory’s plan, deemed “Partnership for a Health North Carolina,” would overwhelm the state’s home-grown, nonprofit Community Care of North Carolina series of Medicaid managed-care networks, opponents to the proposal have said. CCNC saved the state nearly $1 billion between mid-2006 and mid-2010, according to an independent actuary’s report in 2011.
“This is a physician-driven, patient-centered system of care that has saved the taxpayers of (North Carolina) hundreds of millions of dollars over the past several years by giving patients a medical home and coordinated care built on evidence-based medicine,” the local group of physicians stated.
When the reform proposal was announced, McCrory conceded it would not be easy, but said the old system does not work and is not sustainable. The local physicians said a proposal would be a move in the opposite direction, meaning jobs lost and decreased access to care for all citizens, notably the most vulnerable, as some practices such as Clinton Medical Clinic may have to cut services or close.
Jackson said it remains to be seen what form a final Medicaid reform proposal will take.
“I’m waiting with interest in the (N.C. Department of Health and Human Services) recommendation and committee proposals on how to proceed,” said Jackson.
Until then, Bell said he will stand firm that the current proposal is simply not the way to go.
“I think they’re doing a good job with what they have now,” Bell said. “I’m against privatizing almost anything because it takes things out of the hands of the people. They’re not going to receive the same kind of care they would receive. I’m opposed to privatizing. I think we should build up the hospitals we have.”
Chris Berendt can be reached at 910-592-8137 ext. 121 or via email at firstname.lastname@example.org.