Lawmakers confused about Medicaid reform should hold off on changes

July 17, 2014 

Trying to engage in a major overhaul of a huge government program such as Medicaid is, to quote an old song, like changing a flat in a hurricane.

Even many of the Republican legislators in the General Assembly who are working on Medicaid reform don’t seem to understand what it is they’re trying to do. They just say the current system is inefficient.

House leaders want a system led by providers, doctors and hospitals, and they’d give those providers until 2020 before making them responsible for covering cost overruns. The House would leave the Medicaid program where it is, in the Department of Health and Human Services.

The Senate, on the other hand, wants to open the way for commercial companies to compete for Medicaid beneficiaries. And, significantly, Senate leaders would create a Department of Medical Benefits and move the operation out of DHHS.

A not-insignificant problem with the Senate plan is that providers, physicians and hospitals adamantly oppose it.

Premature panic

Republicans have mashed the panic button on Medicaid. Gov. Pat McCrory pronounced it one of the many things in state government that are broken.

But North Carolina’s Medicaid cost-per-person has declined at a time when that figure is going up nationally. And the state has a larger percentage of providers willing to serve Medicaid patients than in other states.

That doesn’t mean the state should just stay with business as usual in a program that, with the federal government paying 66 percent of the costs, provides care for the disabled and the poor. Yes, Medicaid accounts for about 20 percent of the state’s overall spending – an amount that Republicans like to complain takes money away from other programs. But they don’t like to acknowledge that there would be more budget flexibility if not for their shortsighted and excessive tax cuts, benefiting mostly the wealthy and businesses.

A dangerous rush

For all the confusion about Medicaid reform, one thing is certain: Trying to change it at a point in the legislative short session when members are weary and ready to go home – and with a legislature dominated by Republicans who have never taken on a task as big as this one – is unwise.

The state has a legal and a moral obligation to help Medicaid recipients find health care. And that shouldn’t be seen as simply a handout. It’s in the state’s interest to have a healthy population. Medicaid also makes it possible for sick children to become healthy children, something that’s all about the state’s future.

Legislators must not engage in radical reform now. They need more input from professionals. They need a methodical way to ensure efficient care. And they need to go home and see for themselves, in their own communities, how Medicaid is working for their constituents.

No good ever comes from rushed legislation in the General Assembly (the “Speaker Ban” law of the early 1960s from heavy-handed Democrats being the best example). There’s a reason the phrase is wait – and then see.

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