RALEIGH — Lawmakers are poised to deny health coverage to 500,000 people under a measure making its way through the N.C. General Assembly, but the rationale for the move remains hotly contested.
The GOP-sponsored bill to block the expansion of Medicaid under the federal health care law passed the Senate and House, but lawmakers still need to agree to minor tweaks before sending the measure to a supportive Gov. Pat McCrory.
Even though the legislation is near-certain to become law, a leading justification that Republicans used to push the measure is facing scrutiny.
Senate President Pro Tem Phil Berger and other top Republicans argue that the expansion of Medicaid, a government paid health program for select low-income people, would come “at the expense of the private insurance market.”
To support his argument, Berger claims that as many as 80 percent of the new Medicaid recipients nationwide are currently covered by private insurance and only 14 percent are uninsured.
Sen. Thom Goolsby, a Wilmington Republican, took it a step further in a recent video he posted to YouTube, saying an expansion “will immediately take up to 400,000 North Carolinians with private healthcare and place them under Medicaid.”
The Republican lawmakers source their numbers to a U.S. Department of Veteran Affairs-commissioned study from 2011 – but the report’s lead author said this week that their claims misconstrue the results.
Steve Pizer, an associate professor of Health Policy and Management at Boston University, acknowledged, and his paper noted, that “some people will leave their private insurance and pick up public insurance,” but the number is nowhere near 80 percent, particularly for North Carolina because the state offers relatively modest health benefits under Medicaid, lessening the incentive to drop private coverage.
“If you are in a state with relatively restrictive Medicaid and relatively high uninsured rates, which is kind of true for North Carolina, … when you expand it you pick up more uninsured people and fewer on private insurance,” he said.
A Berger spokeswoman said the senator stood by his assertion. Goolsby could not be reached for comment.
A Kaiser Commission study put the national percentage of people with employer-backed health insurance who would move to Medicaid at roughly 11 percent, said Don Taylor, a health policy expert at Duke University. Other experts pointed to a national study looking at the law’s effects in Wisconsin that put the so-called “crowd out” effect in that state at closer to 8 percent.
“It’s conflicting; there’s not really a consensus,” said Jonathan Oberlander, a health policy professor at the UNC School of Medicine.
An N.C. Institute of Medicine study estimated about 25 percent of those new Medicaid patients would come from a private insurance plan.
Mark Holmes, a UNC-Chapel Hill health policy professor, calculated census figures on health coverage to estimate the proportion is no bigger than 30 percent and likely much less. “What we are talking about here is such a big difference than ever before (studied) that it is especially challenging to make reasonable estimates,” he said.
The potential shift is not great enough to concern North Carolina hospitals. The state hospital association opposed the Republican effort, saying Medicaid payments are better than getting little to no money for indigent charity care. In a statement, William Roper, the chief executive of UNC Health Care, said he is still hopeful the state will re-examine its decision not to expand Medicaid.
David Herman, the chief executive officer for Vidant Health, which owns 10 hospitals in eastern North Carolina, including the teaching hospital for the Brody School of Medicine at East Carolina University in Greenville, said the company ran the numbers and estimated a minimal loss of private insurance payments with a Medicaid expansion.
“The numbers would likely be small,” he said. “There are very few families between 100 percent and 138 percent of Medicaid who could afford private insurance.”