A grain of salt with a Medicaid audit

An audit of Medicaid demands action, but is not a condemnation of the program.

February 1, 2013 

State Auditor Beth Wood and her staff have done a valuable public service with an audit of the state Medicaid program that shows, among other findings, disjointed administrative practices, careless handling of federal money that should have been returned but was carried to the next year, higher-than-usual administrative costs, and a lack of oversight. Wood reported that there was overspending of $1.4 billion over the last three years. The program has a budget of about $13 billion a year, counting state and federal money.

New Gov. Pat McCrory could well use the audit as evidence he has been right in his last two campaigns about parts of government being broken, with expense to the taxpayers the result. There’s no excuse for it, at least not one that explains it all. Aldona Wos is his secretary of the Department of Health and Human Services, which is responsible for Medicaid, a federal-state partnership of health care delivery for the poor. She says the problems will be addressed and fixed.

While the situation is unacceptable, it’s important to remember who is not to blame. Those are the recipients of Medicaid, innocent bystanders in this issue. There are 1.5 million people in North Carolina, a state of about nine million, who depend on Medicaid for health care. And federal health care reform could make another 500,000 people eligible, with the additional costs for most of them to be paid entirely by the federal government for several years.

Medicaid expansion is practical as well as humane. If more people are allowed on Medicaid, at the expense of the federal government, the state would save money and the costs in the health care system for others would be lower. Without expansion, which unfortunately is a scenario that’s advocated by Republican leaders in the General Assembly, individuals without any coverage would wind up in emergency rooms when preventive care would have been much less expensive. And those unpaid emergency room costs are passed on to those with insurance.

Some Republican leaders in the legislature will use this audit as evidence that the state’s Medicaid program is so dysfunctional that the last thing it needs is more recipients as allowed by the federal health care reform law. That would amount to political views, namely the Republicans’ opposition to health care reform in principle, trumping common sense and compassion. If those 500,000 additional people who are eligible for Medicaid are simply barred from participating by the state’s intentional inaction, where do they go and what do they do?

To the emergency room, or to sick beds?

The problems in the program that resulted in overspending have to be fixed. But these problems should not be used as an excuse for denying half a million people adequate health care that will cost the state virtually nothing for several years. And the real reason for not expanding Medicaid to take of those citizens – that Republicans in the legislature don’t like President Obama and his health care reform act – isn’t good enough.

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