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Tackling Medicaid in North Carolina

We don’t know if Gov. Pat McCrory was sincere or not when he said last week that he’s open to expanding Medicaid once a plan is in place to fix its unpredictable cost problems. But it was good to hear. He told WFAE’s Mike Collins when asked if he’d expand Medicaid: “I’m leaving that door open. Once we fix the current system, I have not closed that door as governor.”

Of course, there are a few stumbling blocks to McCrory even getting the chance. N.C. lawmakers passed legislation last year to prevent the state from accepting Medicaid expansion, and the legislature’s Republican leaders – House Speaker Thom Tillis and Senate President Pro Tem Phil Berger – are against expansion.

And currently, lawmakers remain divided over how to overhaul the $13 billion program that covers about 1.7 million low-income children, some parents, disabled and elderly people. The Senate plan allows provider-led and commercial managed care organizations to compete for enrollees. The House proposal, which McCrory prefers, allows only provider-led Medicaid networks to operate in the state. Both say providers will be responsible for cost overruns in the future.

We think the Senate plan has problems, too. It would take control of the Medicaid program from the state Department of Health and Human Services and give it to a new Department of Medical Benefits that would be run by a paid board of directors. The board would include mostly people with corporate experience, and exclude medical providers or people employed by hospitals or universities. Such a board does not appear designed to have the best interests of those receiving medical care in mind.

A recent (Raleigh) News & Observer series showed that parts of the N.C. Medicaid program work. Costs per person have decreased as spending nationally has gone up. More providers in the state, compared with the national rate, are willing to participate. And services are better, especially preventive care, than in many other states. An overhaul that throws out all that good to fix the bad is wrongheaded.

We hope lawmakers can reach agreement on a plan that doesn’t do that. We also hope they, like McCrory, will keep the door open – or rather open it again – on expansion. Other GOP governors have done so, including Indiana Gov. Mike Pence, whose state’s plan is tailored to that state’s needs. McCrory said he talked with Health and Human Services Secretary Sylvia Mathews Burwell about “waivers to adapt to what North Carolina needs.”

Medicaid is a valuable and needed service in this state. It helps a lot of people, and can help more. The governor seems to understand that. We hope lawmakers crafting an overhaul do as well, and that it is reflected in their final plan.

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