NC Medicaid makes an important difference for those with no alternatives

July 7, 2014 

One overall lesson from The News & Observer’s recent two-part report on the Medicaid health care system is that the system in North Carolina is in many ways working well.

Costs per person have gone down at a time when spending nationally has gone up. More providers in the state, compared with the national rate, are willing to participate in services, percentage-wise. And there is better preventive care under N.C. Medicaid than in other states.

Certainly the program has problems, and those problems didn’t originate under Republicans and the administration of Gov. Pat McCrory. But there is a threat that Republicans, having cut taxes excessively and seeming confused by the challenge of putting together a budget, will look to cut Medicaid services as an “easy” savings. It will be easy in the sense that recipients of Medicaid help can’t match the clout in the General Assembly that insurers, pharmaceutical companies and hospitals have.

It is always important, therefore, to remember who pays the price for cuts in those services and what type of pain changes in Medicaid inflict on vulnerable people.

A story from The News & Observer’s Joseph Neff illustrated just that.

Mason Leonard, 14, of Cary is severely disabled. He was brain-damaged at birth and cannot care for himself. He can’t be left alone, can’t feed himself or look after any of his needs.

But thanks to a few Medicaid services, he receives therapy, gets out a little, gets trained in things like making his bed, which, when he accomplishes it, is considered a big step.

His mother, Colleen Leonard, values the services. And she would like to have an opportunity to make the case for how important the services are to Mason and other Medicaid recipients. That’s why she wanted to respond to a request for public input from the state Department of Health and Human Services on the subject of reforming Medicaid.

But Leonard, who’s savvy about how these things work, was distressed by the six-page form she got from DHHS. It had lots of jargon and was aimed primarily at providers, not recipients of services.

Those providers and lobbyists for others with interests in Medicaid, by the way, also happen to be generous with contributions to politicians. Rep. Nelson Dollar, a Cary Republican and House budget-writer, reported in his most recent campaign report, for the second half of last year, that he got $164,000 from doctors, dentists, speech pathologists and others with a stake in Medicaid.

Dollar says all views have been heard.

It would be just as valuable, perhaps more so, for lawmakers and policymakers from DHHS to meet people such as Mason Leonard.

A Medicaid policy change last year, for example, eliminated weekend hours for teaching Mason how to function with basic skills. His mother understandably fears what new hardships further “reform” will produce.

Here is what the public needs to understand about the budget cutting and reform conducted under the banner of “efficiency.” For each cut, for each decision to eliminate some benefit, a disabled person such as Mason Leonard or a poor person with no alternative for care except what Medicaid provides and their caregivers and family members suffer discomfort or pain.

The Medicaid program has problems with computer services and with organization. But the N&O’s examination found that much of it is working and that the state’s services under Medicaid are better than those in many other places, a point of which to be proud.

Let us hope that as Republicans continue to work on their budget changes, they will see more than numbers. For in the end, it’s not about numbers. It’s about people.

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