Point of View

An insurance exchange for North Carolina

November 25, 2012 

Now that President Barack Obama has been re-elected and the threat to the Affordable Care Act has diminished, North Carolina leaders must shift into high gear and begin the important work of developing plans to make insurance coverage accessible to everyone, including those with limited means, with pre-existing conditions and with jobs that don’t offer health coverage.

A good first move was the recent decision by Gov. Bev Perdue to forge a partnership, at least in the short term, between the state and federal government to establish a marketplace where uninsured citizens and employees of small businesses can buy affordable health insurance.

These insurance exchanges will be required next year and can be operated by the states, the federal government or both. By declaring the state’s intention to form a joint effort with the federal government, Perdue preserved options for the next administration to forge a different path.

That path should be for an insurance exchange run solely by the state, which would give much greater control and oversight to state leaders. Some in the General Assembly have been reluctant to move forward. But the fact is, much of the required planning has already been done by North Carolina’s departments of Insurance and Health and Human Services, aided by the guidance and insight of the N.C. Institute of Medicine and in close cooperation with our state’s health care leaders.

Incoming Gov. Pat McCrory should build on that effort with great urgency and resist any political pressure to cede the state’s responsibility for running the exchange to the federal government.

There is no time to waste. By this coming February, states must submit plans for how the exchanges will operate. An even bigger deadline looms next October, when the exchanges will open to hundreds of thousands of residents who will start purchasing policies and enrolling in the new plans for coverage starting in January 2014.

Yet that’s only half of the people who will gain access to health insurance under the Affordable Care Act. Starting in 2014, another 560,000 North Carolinians could be covered by Medicaid, which has traditionally insured low-income mothers and their children. Under the new law, this program will be expanded to provide Medicaid benefits to anyone under the poverty threshold.

While some officials in other states have balked at the expense of expanding Medicaid eligibility, it is critical that North Carolina’s leadership participate in this fundamental component of the Affordable Care Act. Funding would largely come from Washington. The state’s cost between 2014 and 2019 would be $830 million, while the federal government would provide more than $15 billion.

That is money that will help people remain healthy, productive and contributing to the economy. It will also save money long term, enabling many more of our citizens to access care through the “front door” of our health care system, instead of being limited to the episodic, fragmented and expensive care that results when the emergency room – the “back door” to the system – is their only option.

Here again, much work has already been done. Health leaders have been revising the delivery systems to provide portals for patients to access care more affordably. Physician practices throughout North Carolina, including Duke Primary Care, have been working to organize themselves as medical homes, where patients receive health management, not just disease treatment. Through medical homes, patients are coached about staying on their medications, finding diet and exercise programs, and getting follow-up care after they’ve been discharged from the hospital.

This is a major difference in the way care is typically provided, and North Carolina has been a national leader pioneering such efforts – not just for those on Medicaid, but for all patients in the state.

All of this hard work is critical to the success of the Affordable Care Act, but beyond that, it advances goals that we can all agree are laudable: expanding access to health care, enhancing the quality of that care and lowering the costs.

The issue of health care is one that affects us all and literally has life and death consequences when people cannot afford to seek the care they need, when and where they need it.

So let’s all join this important movement. It’s now time to come together without hesitation and work to improve health care, and access to health care, in our state. The time for idling is over.

Victor J. Dzau, M.D., is president and chief executive officer of the Duke University Health System and chancellor for Health Affairs at Duke.

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