Under the Dome

Calls for Medicaid expansion, limits on paperwork, in health insurance overhaul

Speakers at the first formal public hearing on the state’s planned Medicaid overhaul said they wanted the government insurance expanded to cover more people, worried that increased paperwork would drive away doctors, and asked why the state was changing a system at all.

The state Department of Health and Human Services is preparing to ask the federal government to approve major changes in Medicaid that will have most of its beneficiaries sign up for health plans run by insurance companies, hospitals or other providers. Medicaid privatization was a priority for legislators last year.

State health officials said the changes will give beneficiaries more options, improve health, and contain costs. The state would no longer pay for each doctor’s visit or procedure, but would pay the health plans a set sum for each patient enrolled.

Medicaid covers 1.9 million people, mostly low-income children and their parents, the elderly and the disabled. It costs the state about $14 billion, with the federal government paying about two-thirds.

The legislature does not want to expand Medicaid under the Affordable Care Act. Expansion would give about 300,000 to 500,000 low-income adults access to health insurance. There’s been a steady public push for expansion over the years, and several speakers at the Raleigh hearing, including doctors, health advocates, and one college student and mother, said expanding Medicaid should be part of the overhaul.

The federal government picks up all the costs of expansion for three years. After that, the state’s share rises over several years to 10 percent.

“Reform and expansion are complementary,” said Dr. Jonathan Kotch, a research professor in public health who was representing a group called Health Care for All.

Thousands of newly insured people with mental illnesses would be able to find treatment, said Dr. Marvin Swartz, who represented the NC Psychiatric Association.

Anticipating speakers’ emphasis on expansion, DHHS Secretary Rick Brajer said before comments started that expansion would be discussed with the federal government and the legislature.

“We’ll have the discussion,” he said. “Where we come out on it is where we come out on it.”

The overhaul envisions more than a dozen Medicaid health plans in the state. Doctors said they worried that an increased paperwork burden would be onerous and force some of them to stop seeing Medicaid patients.

Dr. David Tayloe Jr., a pediatrician from Goldsboro, said he has thousands of Medicaid patients in seven counties. Tayloe said may not be able to continue operating as he does because he’ll have to deal with more than a dozen payers rather than one, and his Medicaid overhead will increase from 6 percent to 12 percent.

Tayloe said the state’s current Medicaid healthcare system, called Community Care of North Carolina, is admired around the country.

“Why in the world are we going to tinker with a program that’s been so effective?” he asked.

DHHS will hold a series of public hearings throughout the state through mid-April in preparation for submitting its application to the federal government by June. 1. It will be three to four years before the changes kick in.

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