With new Medicaid plan, time to expand

February 27, 2014 

Toss another revolutionary idea from the administration of Gov. Pat McCrory into the dust bin. After proclaiming the state’s Medicaid system “broken,” McCrory and his embattled secretary of the Department of Health and Human Services, Aldona Wos, dangerously flirted with turning the federal-state health care plan for the poor, elderly and disabled over to managed care organizations.

It was a misguided idea, and doctors and health care providers quickly jumped all over it. It would not help the poor, they said, and it would not improve care. It would make a mess of reimbursements and everything else in the system.

It was clear as well that the governor didn’t really understand the fine points of how the change would work, and neither did Wos, who is a medical doctor.

There were more devils in the details than Blue Devils in Krzyzewskiville.

And the alleged “breaks” in the system were used as an excuse by Republicans not to allow Medicaid expansion in the state that might have made 500,000 more people eligible for the program. What Republican lawmakers and McCrory were really up to was taking a slap at President Obama’s health care reforms, of which Medicaid expansion, paid entirely by the federal government, was a part.

A better idea

Now, having returned from a trip to the drawing board, McCrory and Wos say they support an idea that will encourage doctors, hospitals and clinics to form networks called accountable care organizations. The providers would control the networks, and a program that coordinates care for Medicaid patients, Community Care of North Carolina, will be preserved. That’s good. Community Care works.

The accountable care groups would sign up providersand try to control costs, though the providers would be paid as they are now. That might save money in the future.

This is all well and good, but it’s too bad that in the course of the McCrory administration’s fiddling over all this, and continuing to talk about its managed care ideas, there remained half a million North Carolinians who needed Medicaid coverage and couldn’t get it.

Call for expansion

McCrory could now take a really significant step and support expansion of Medicaid. If he and GOP leaders in the General Assembly did that, it would answer critics who say they are unbending ideologues.

The state still has much to do in helping mental health patients. That’s an area that has been neglected, though certainly some individuals have worked to keep mental health care in the forefront of debate.

The Medicaid stumbling calls to mind the unfortunate plan in the Department of Commerce to privatize economic development and business recruitment. In that case, as with the chest-beating about Medicaid, the rhetoric was much easier to deliver than the reality. The Commerce plan now seems mired in confusion and disorganization.

Thankfully, the governor recognized that in Medicaid, he could make a change that might help patients and make the delivery system more efficient. He responded as well to doctors and hospitals, who have powerful lobbying voices and recognized that a $13 billion Medicaid system is not something to be revolutionized just like that. The system is complex, relying on private providers and government regulators and patients to come together.

The McCrory administration has taken the right, reasonable and moderate step. Now it should take the next one – expand Medicaid.

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