In Medicaid muddle, North Carolina patients lose

Republican legislators are all too eager to grant more tax cuts to the wealthy and to businesses, reducing state revenues. But when the disadvantaged, the disabled and the elderly are involved, GOP lawmakers are willing to roll the dice, and they don’t seem to care whether they come up snake eyes.

Now comes a plan to privatize the state’s $15 billion Medicaid program, which for most recipients has been ably administered by a network of doctors called Community Care of North Carolina. Yes, the program is expensive, though two-thirds of the cost in providing health care for the poor, elderly and disabled is covered by the federal government. But Medicaid saves lives, and without it, those with no health care alternatives would be left to emergency rooms. That, by the way, would affect everyone else who goes to an emergency room.

GOP lawmakers want to install a managed care system in which Medicaid would be put under a new division in state government and come under the control of three contracted companies offering managed care plans. Groups of doctors and hospitals would enroll people in regional managed care networks. And Medicaid no longer would pay for each hospital visit or medical procedure for the 1.8 million enrolled in North Carolina. The companies would get a fee for each patient at the time of enrollment. If the cost of care ran over the fee, the companies would be liable.

In other words, it’s money first, people second.

This is a terrible idea. First, as has happened in other states that have tried this system, companies that find they can’t make money leave. Bob Seligson, CEO of the state Medical Society, notes that expenses also can go up. Hospitals and doctors have fought this very bad notion for years, and they’re the ones on the ground providing care.

But thanks to some ideologically driven Republicans, the views of the experts are tossed out the window. Amateurs on Jones Street are moving away from Community Care of North Carolina, which has done a splendid job, for a system that has decidedly inconsistent results.

The idea will need the approval of the federal government, so with any luck this foolishness will be rejected in Washington.

Once again, Republican legislators move to fix something that’s not broken, even when their decisions could put the health of their constituents in peril.

This story was originally published September 18, 2015 at 3:50 PM with the headline "In Medicaid muddle, North Carolina patients lose."