Point of View

Shutting the doctor’s door in Tar Heel faces

February 17, 2013 

As a clinical AIDS researcher in South Africa and Malawi, I know firsthand what it looks like when societies with over-burdened health systems can’t provide basic care for their citizens. And yet when I arrived back in North Carolina this month, I was shocked to learn that leaders in our own state are now doing everything in their power to take us down those same catastrophic paths.

By willfully rejecting an expansion of Medicaid for thousands of hard-working North Carolina families, Gov. Pat McCrory is relegating many of them to the same fate as many of my patients in Africa – dying needlessly for the simple lack of appropriate preventative care.

In North Carolina, we suffer from high infant mortality (46th in the nation), low birth weight (44th) and diabetes (42nd). We rank in the bottom 20 states for premature deaths (37th), cancer deaths (33rd) and cardiovascular deaths (32nd). We are not a healthy state.

With so many poor medical outcomes that can be prevented with access to good care, why has the governor decided to deny 500,000 working and tax-paying North Carolinians access to health insurance?

In making a decision based on his own narrow ideological and partisan political goals, McCrory has guaranteed that the rest of us will see our own health costs skyrocket and our insurance rates continue to rise. This is a shame because expanding Medicaid in North Carolina would not only give workers access to preventive care but also would save an estimated $65.4 million for our state and for our local governments.

Moreover, expanding Medicaid would bring almost $15 billion in federal funds into our state, an expansion that could create 25,000 jobs by 2016. With unemployment in North Carolina over 9 percent, that only makes McCrory’s decision seem even more irrational.

Many hospitals in North Carolina, especially in rural areas, provide millions of dollars in uncompensated care. This strains their budgets and puts pressure on hospitals to get higher payments from private insurance companies. Expanding Medicaid will help alleviate this problem.

The federal government will fund the entire cost of the expansion for the first three years, and that percentage never falls below 90 percent before 2020. Premiums for private insurance, my insurance and yours, will be at least 2 percent higher in states that do not expand Medicaid due to cost shifting. Every year that North Carolina delays implementing the Medicaid expansion, the state surrenders billions of dollars in federal funds that will go to other states to bolster their economies.

Even conservative Republican governors in Arizona, Florida, Ohio, Michigan and Nevada agree with me.

Arizona Gov. Jan Brewer became a right-wing hero when she was able to get her state to pass one of the harshest immigration laws in the nation. Yet in her State of the State address the other day, she spoke in-depth about the need for Medicaid expansion. “Weigh the evidence and do the math,” she said. “With the realities facing us, taking advantage of this federal assistance is the strategic way to reduce Medicaid pressure on the state budget.”

McCrory explains away his decision to break with his conservative colleagues by falsely pointing to a “broken” system, even though it was aggressive budget cuts by Republican legislators in 2011 that defunded a previously healthy system. In fact, from 2007 to 2010, North Carolina had some of the lowest spending growth rates in the South, due in part to effective patient management.

Perhaps most ironically, the federal funding for Medicaid expansion includes extra resources to make Medicaid even more efficient and accountable.

Rather than shutting the doctor’s door in the face of half a million working North Carolinians, McCrory should seek to increase access to health care. North Carolina should use its authority to expand Medicaid to these hard-working families because it saves the state money, lowers health care costs for all of us and creates accountability by streamlining the health system.

That McCrory has chosen a different route – one more divisive and deadly – is one all North Carolinians would do well to remember.

Charles van der Horst is a professor of medicine at the University of North Carolina at Chapel Hill.

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