As family physicians on the frontline of our state’s health care system, we know the facts about Medicaid. That’s because family physicians, pediatricians and other primary care providers serve as the medical home and primary point of care for our state’s Medicaid recipients. While we have been very vocal in our support for curing the ills of the Medicaid program, we also want to make sure that we’re diagnosing the right illness.
This complex state and federal government health insurance program demands proficiency in administration and financial management – something this state has not always had. To their credit, this General Assembly and Gov. Pat McCrory’s administration have taken on the challenge of addressing Medicaid’s single greatest ill: improper budgeting and cost forecasting. Thanks to the changes that have been made, last year’s Medicaid budget had a slight surplus, and this year’s budget appears to hold similar promise.
Unfortunately, some would use Medicaid’s complexity to develop myths about a monster gobbling the state’s resources to take care of those who should be working. This is simply not true. Two of the Medicaid myths that just won’t seem to go away:
1Medicaid spending is out of control. Much of the Medicaid reform rhetoric would have you believe that costs are out of control. That simply is not true. Through recent improvements in forecasting, the work of our state’s award-winning care management infrastructure, good decisions by our legislature and the hard work of frontline physicians across the state, Medicaid costs per patient have decreased roughly 9 percent in the past four years, with administrative costs ranking among the lowest in the country.
Recent data analysis shows that while Medicaid enrollment has increased significantly, the state’s portion of program costs has actually remained flat. Yet, over the same five-year period, the number of North Carolinians covered by Medicaid has increased from under 1.5 million to 1.8 million people.
When state and federal dollars are combined, total spending on North Carolina’s Medicaid program increased only about 8 percent between 2010 and 2014, while the number of enrollees in the program increased by 20 percent. Most private-sector employers would be thrilled by such positive results.
North Carolina has actually done a great job controlling spending. In fact, given the enrollment growth Medicaid has experienced, one would have expected spending to increase much more than it actually did. And bringing in out-of-state managed care companies won’t do one thing to change the number of recipients enrolled in Medicaid. So let’s look at the facts and not propagate fiction. North Carolina’s Medicaid spending is not out of control.
2Medicaid is just another entitlement program for able-bodied adults. Almost 65 percent of the individuals on Medicaid are poor children who would otherwise have no health insurance. Another 2 percent are women who qualify only because they are pregnant. Roughly 15 percent of the recipients are blind or disabled, and approximately 7 percent are the elderly. The small proportion of recipients remaining represents the working poor.
So who is really on Medicaid? It could be your grandmother. Many of our elderly citizens end up on Medicaid after depleting their savings. As we live longer and require more expensive care, even those who have significant savings can burn through those funds quickly. In most cases, Medicare, the national insurance program for the elderly, does not cover long-term care, such as nursing homes. This means once your savings are gone, Medicaid is likely your only option. As we get older, we spend more on health care, making the elderly some of the most expensive Medicaid recipients.
The program also provides health insurance for the blind and those who are disabled, particularly those children born with a disability who need ongoing care throughout life.
Medicaid patients are grandmothers. The blind. Those born with a birth defect. These aren’t exactly able-bodied workers simply looking for government coverage. So let’s make sure we know the facts about Medicaid before demonizing those who need care. Tomorrow, it could be you.
So why then are some beating the drum for more drastic measures of reform? Why do some want to turn our health care over to out-of-state, profit-driven insurance companies? Could it be that the sheer complexity and misunderstanding of those Medicaid serves provide ample breeding ground for myths? If these myths go unbusted, they certainly would create a monster demanding inappropriate reforms solely for reform’s sake.
“Myths” and “monsters” are great for campfires but are not what the doctor ordered when debating responsible reforms to the health care coverage for 1.8 million North Carolinians. Rather than chasing myths and monsters, let’s fix what is broken and build on what’s already working in North Carolina.
Thomas R. White, M.D., of Cherryville is president and William A. Dennis, M.D., of Henderson is chairman of the board of the NC Academy of Family Physicians.