All the reasons for NC to expand Medicaid

In recent years, North Carolina hospitals have been cutting back on services and staff. The smaller hospitals especially in the rural counties are struggling to survive economically. Expanding patient enrollment in Medicaid would be a strong economic boost for our state. Economists project that it would add 25,000 to 30,000 jobs widely dispersed in almost every county.

All hospitals have to absorb the costs of providing health care to uninsured patients, which hospitals are ethically and legally obligated to do, even if it generates red ink for their budgets. Their caring for uninsured patients creates more upward pressure on commercial health insurance premiums as a result of cost shifting within the hospital economics.

Our state-supported medical schools in Greenville and Chapel Hill have had their allocations from the state of North Carolina cut about 40 percent in the last five years. Still, their faculty and affiliated hospitals treat a large number of uninsured patients. To have remuneration for that work would be a tremendous boost to their difficult economic plights. Of course, our state benefits greatly from the education and training these institutions provide for physicians, surgeons and multiple other health care professionals who commit their careers to treat our residents, many of whom are uninsured.

Under the Affordable Care Act, Medicaid

could be expanded to include persons whose incomes are up to 138 percent of the federal poverty level. For the first three years, the federal government would cover 100 percent of the costs and after that no less than 90 percent. There would be some administrative costs for the state to accomplish such expansion, but it probably would be much less expense to North Carolina than the proposed expansion of the incentive program for trying to entice industry to come to our state.

It is evident that Republican politicians do not like the Affordable Care Act. It is a cumbersome piece of legislation that incorporates many compromises with special interest groups, but it serves a fundamental purpose of shrinking the number of uninsured people in this nation. This act could benefit from some thoughtful refinements, but it is not the failure that was predicted. In fact, it has contributed to a decrease in the growth rate for health care costs and has increased the portion of our residents with health insurance. The latter fact is true even in states such as North Carolina that have refused to expand Medicaid.

The taxpayers of North Carolina through their federal taxes are subsidizing Medicaid expansion in almost 30 other states even as we decline to accept this opportunity for our own residents.

Currently, uninsured patients get no health care at all, use emergency departments or have doctors, nurses, clinics and hospitals provide their care at no charge. The great majority of uninsured patients rely on the ED, which is not effective for managing chronic disease or for appropriate screening to pick up problems early when they are manageable.

The episodic care through EDs is far more expensive and less effective with clinical outcomes than if the patient were established with a primary care medical home. Data show that chronic disease management gives a better quality of life and a longer life expectancy. Mental health would be much improved with fewer suicides. And back to economic considerations, the most common cause of bankruptcy is medical problems with no health insurance.

Let us hope our legislators and governor will move forward soon to expand Medicaid in North Carolina and so benefit the economy across the state, help struggling hospitals and health care institutions, and make life dramatically better for nearly half a million people in North Carolina who have no health insurance.

Robert H Bilbro, M.D., retired, is cofounder of Raleigh Medical Group.