Point of View

Baffling comments from NC’s Medicaid director

March 21, 2013 

Businessman falling



Gov. Pat McCrory’s new state Medicaid director recently gave a troubling rationale for the governor’s refusal to expand Medicaid to 500,000 poor North Carolinians:

“If I gave 700,000 people who don’t have health care coverage a Medicaid card in North Carolina, do you really think they would get healthier?” Carol Steckel asked.

Her statement seemed to imply that she thinks the program she directs is incapable of helping the people who would have been added to the rolls. She said low-income people without Medicaid cards can go to federally qualified health centers, which are focused on primary care and receive billions of dollars to offer sliding-scale fees.

Steckel’s position doesn’t jibe with the facts.

Just a few years back, the nonpartisan and respected N.C. Institute of Medicine convened a blue-ribbon task force led by state officials, business leaders, medical providers and local experts to look into the safety-net question. The group’s conclusions were stark:

“On the surface, it appears that North Carolina has a wide array of safety-net organizations. However, the task force determined that only 25 percent of all the uninsured receive primary care services from safety-net organizations. Further, even in those counties with adequate primary-care capacity, there is often insufficient access to pharmaceuticals, specialty care, behavioral health and dental services.”

The task force urged maximum use of Medicaid funding as a major strategy to increase health care availability.

In other words, Steckel’s assertions about Medicaid alternatives are directly contradicted by experts who spent more than a year studying the very subject. Those experts – many of whom have devoted their lives to delivering safety-net health care in our state – concluded that the “alternatives” met only a fraction of the need and that the best way to improve the situation was more use of North Carolina’s Medicaid system.

The Medicaid program provides high-quality medical care, according to some recent research published by experts at Harvard and MIT in the New England Journal of Medicine. A study published just last year found significantly lower death rates among poor adults in states where Medicaid was expanded. This follows similar research in the Journal in 2011 documenting not only better health outcomes from Medicaid coverage, but also drastically increased financial security.

As one of the state’s most visible leaders on the subject of public health, Steckel should take great care with comments on North Carolina’s Medicaid program and with messages she delivers to folks in the trenches.

After all, one of the main reasons North Carolina’s Medicaid program has become a national model with the lowest cost growth of any program is the widespread commitment of primary health care providers, hospitals and other health institutions to the system. Indeed, these health organizations have undertaken herculean efforts over the past two decades to work together in an effort to improve care and to lower costs in our Medicaid program.

These same providers understand that our safety-net system of health clinics alone simply can’t meet the huge health care needs in our state without a dramatic expansion of Medicaid. When the program’s new boss inaccurately portrays the situation, it may make them think twice about carrying on with such work.

Adam Searing is the director of the N.C. Health Access Coalition.

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