Point of View

Another chance for NC lawmakers to get it right on Medicaid

December 22, 2013 

  • Want to go?

    The Forward Together Moral Movement’s Special Redemptive Service is today at 4 p.m. at the State Capitol.

At the State Capitol today, the Forward Together Moral Movement will encourage the governor and the General Assembly to redeem themselves by convening a special legislative session to repeal the law that bans expanding Medicaid in North Carolina.

What the governor and lawmakers have done is less than honorable. Showing no compunction, they’ve neglected the health of low-income North Carolinians. These residents deserve better at the hands of their elected officials. Sadly, Gov. Pat McCrory and his legislative lieutenants have prohibited North Carolina from obtaining federal funds for as many as 500,000 needy North Carolinians.

Cleverly, they’ve camouflaged what they’re doing and rationalized their actions by saying in effect, “We can’t sustain the expense. Our Medicaid program needs reform first.”

But under the Affordable Care Act, the federal government will cover 100 percent of the program costs for the first three years and 90 percent until 2022.

And in April, the U.S.’s Healthcare Leadership Coalition awarded Community Care of North Carolina its Wellness Frontier Award. Attending this ceremony, U.S. Sen. Richard Burr, a Republican, said “I’m pleased that a North Carolina program was recognized as a model for how to improve outcomes for patients and get more value out of our health care system.”

CCNC manages care for 1.3 million of the state’s 1.6 million Medicaid patients!

These rationalizations are excuses for an appalling amount of neglect – neglect that will lead to preventable deaths. Regrettably, the governor and his legislative cronies may not act to prevent an estimated 2,820 unnecessary deaths. But if they were to reverse themselves, they could prevent one death for every 173 newly enrolled Medicaid recipients.

Tragically, however, neither branch of government shows signs of forward progress, repeated pleas to act notwithstanding. This obdurate behavior is a gross perversion of political power.

We want leaders who will preserve lives, not orchestrate death and neglect. Just what have these impoverished North Carolinians done to deserve such treatment?

Besides preventing deaths, the governor and the legislature could also reduce needless suffering. In this regard, they should take some tutelage from the state of Oregon.

In 2008, Oregon had the financial wherewithal to initiate a limited expansion of Medicaid, which it did by conducting a lottery. Winners became Medicaid recipients. This approach, essentially a randomized clinical trial, gave researchers a powerful opportunity to study public policy, and indeed Katherine Baicker and her colleagues from the Harvard School of Public Health did just that. They followed up 12,229 individuals, to include 6,387 who received Medicaid benefits and 5,842 controls who didn’t.

They identified individuals with depressive mood disturbances and found that 30 percent of the control group (1,753), but only 21 percent (1,328) of the Medicaid group experienced such symptoms. Medicaid had clearly reduced these disturbances by 9 percent. Furthermore, given this degree of effectiveness, one patient out of every 11 Medicaid recipients enjoyed a “substantial” improvement in their mental health.

Applying these figures to North Carolina’s 500,000 potential beneficiaries means that 150,000 would have depression-related symptoms. A 9 percent reduction would mean that after two years, 13,500 patients could enjoy improved mental health.

While politicians may dispute, deny and dismiss such medical evidence, they do so without a smidgen of the credentials held by investigators, peer reviewers and the editorial staffs of medical journals.

Instead of spurning this evidence, the governor and the General Assembly should dole out a little Christmas-time kindness to their half-million needy constituents, but if they can’t do that, they should reflect upon the hypocrisy of having health care for themselves while denying it for others.

North Carolina needs to stop neglecting the health of 5 percent of its population and align itself with 24 other states that are expanding their programs. (Four of these have Republican governors.)

Shouldn’t our elected officials want to prevent unnecessary deaths? Shouldn’t they want to improve their constituents’ mental health? Is this really asking too much of them?

Edward Squire, M.D., is a retired physician living in Seven Lakes.

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