It was not encouraging when, during a forum in Reidsville on how to deliver Medicaid to North Carolinians, state Department of Health and Human Services Secretary Dr. Aldona Wos cited Insurance Commissioner Wayne Goodwin as the reason Medicaid wasnt expanded to include another 500,000 working class state residents.
The reason, of course, was the determination of Republicans in the General Assembly to take a stand against President Obama and the federal governments offer to provide the money for additional people free of charge to the state. Turning down the offer, which will hurt hundreds of thousands of people and their families, was nothing more than an ideological and political stance, and it was a horrible decision.
Wos needs to be fully informed as to the state of Medicaid before she takes her show on the road, the intention of the show being to get community input, including comment from doctors, as to how the state can best deliver care.
Governor McCrory, in the name of saving money, wants to convert the delivery of Medicaid to three or four managed care organizations. They would run the show for a set price, and both the companies and doctors would share some financial risk if, for example, services wound up costing more than anticipated.
Many doctors seem to prefer a setup such as Community Care of North Carolina (CCNC), a network of doctors that focuses on preventative care and monitoring those with chronic illnesses, the aim being to keep them out of emergency rooms and more expensive care. Under McCrorys plan, CCNC wouldnt continue, unless it wanted to be one of the bidders for services.
CCNC seems to work well. The state would do well to encourage its expansion.
Carol Steckel, state director of Medicaid, said CCNC needed to include mental health care. Doctors have advocated that the program be expanded to do that, and that hospitals be drawn into the mix as well.
In any case, by going out and talking to people, Wos has a chance to get some meaningful feedback and its hoped, to take some of the ideas back to the governor, who should remain at least somewhat flexible.
Unfortunately, McCrorys representatives, Wos and Steckel, are apparently limited in what they can say. When, on Wednesday in Durham, a professor of medicine at UNC-Chapel Hill said the decision not to expand Medicaid was bad from a public health standpoint, all Steckel would say was, We hear your opinion about the Medicaid expansion. Lets talk about how we can improve the existing Medicaid program.
Getting input about Medicaid from different areas of the state is a good idea, but it will prove a productive idea only if Wos and Steckel do more than listen.