Point of View

Future of Medicaid in NC too important not to work together

October 23, 2013 

Though North Carolina was one of 26 states to reject Medicaid expansion, Medicaid reform will be vigorously debated in the year ahead. Moving forward, Gov. Pat McCrory and the legislature have some very tough decisions to make.

To decrease costs, the governor has proposed privatizing Medicaid and increasing competition among managed care plans. Currently, a five-person panel – one member selected by the state Senate, one by the House and three by McCrory – is studying the issue. Whatever the panel recommends and the governor and lawmakers decide, health care quality, access and costs are going to be major challenges for North Carolina and our country.

From hospitals that are major employers in many communities to doctors trying to take care of patients and run small businesses to teachers who see cost overruns deplete the state budget and, most importantly, to the patients who are served, it is vital that Medicaid provide quality care that is also fiscally sound. Recent notices of rising insurance premiums remind us that health care financing is always a community process.

Thanks to advances in medicine and public health, the average lifespan in the United States over the last 100 years has risen from 48 to 79 years. We now spend 18 percent of our Gross National Product on health care. Medicaid spending is the fastest-growing part of our state budget. We spend $14 billion ($11 billion federal and $3 billion state) on Medicaid in North Carolina. The Department of Health and Human Services has a $17.6 billion budget with 16,329 employees, 400 of whom handle 88 million Medicaid claims.

Medicaid expansion would have covered an estimated 318,710 more patients in North Carolina. U.S. Census projections estimate North Carolina will be the seventh-most populous state in 2030, with a corresponding increase in Medicaid patients.

For those who find our challenges daunting, North Carolina’s history gives us hope. Frank Porter Graham, upon the dedication of N.C. Memorial Hospital and UNC Health Center in April of 1953, remarked: “Here in Chapel Hill, beyond the shadows of a broken world, spring and youth lift their faces in beauty and hope toward the better day of their unbroken dreams.” In addition to the end of a recent world war, the broken world the former UNC chancellor referred to was embodied by the poor health of North Carolina residents. About 50 percent of North Carolinians trying to join the military during World War II were rejected for health reasons – the worst rate of the then-48 states.

Determined to improve health care in North Carolina, Gov. Melville Broughton in 1944 created a North Carolina Hospital and Medical Care Commission of 60 residents that called for “More Doctors, More Hospitals and More Insurance.” This subsequently led to the Good Health Movement in 1946 and, upon the recommendation of an advisory panel, to the creation of North Carolina Memorial Hospital, UNC’s four-year School of Medicine, School of Dentistry, School of Nursing and efforts to expand health care statewide.

How did they do it? In his dedicating speech, Graham acknowledged all those who had worked together and talked of the “joyous adventure in the creative cooperation of … great medical schools ... all the hospitals, and all the colleges and agencies of people’s life, rising together to build in North Carolina one of the major coordinated university medical centers of the modern world.”

Nearly 60 years later, Graham’s dream for a better day for health care in North Carolina is closer to realization. North Carolina has world-class medical centers, and UNC Health Care, Duke, Wake Forest Baptist Health, Vidant, Novant, Carolinas Healthcare, local hospitals, DHHS, the N.C. Medical Society and Community Care of North Carolina strive daily to reach across the state to serve our residents.

Skipper Coffin, a former faculty member at UNC’s School of Journalism, said upon his retirement that he and his colleagues had been “consecrated to the common good.” Improving Medicaid requires our efforts to be collaborative and our analysis thoughtful. North Carolinians know that we can work together to the common good because we have done it before. In doing so, as one of my ministers reminds me, we build together not to find middle ground but to help each other get to the higher ground.

Dr. Randall W. Williams, M.D., of Raleigh served on the Gov. Pat McCrory’s Health Care Transition Team.

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