How lawmakers in Raleigh are putting 1.8 million people at risk

Gov. Pat McCrory has long resisted expanding Medicaid under the Affordable Care Act, despite health care advocates’ contention that the $2 billion-a-year federal infusion would create 43,000 new jobs and save the state $318 million.

I want a North Carolina Medicaid plan, he kept saying.

The Medicaid overhaul he signed Wednesday? It targets a well-regarded program created by North Carolina doctors and healthcare providers and sets it up to be overrun by private managed care firms from out-of-state.

Yes, that’s “managed care” as in HMOs – the kind that left us all spitting mad in the 1990s as they squeezed healthcare costs, denied access to doctors and put their own profits above patient safety.

They weren’t good enough for the general public then. But North Carolina, like a growing number of other states, says they’re good enough for poor folks who depend on Medicaid.

Regardless of whether it saves money, patients seem almost certain to get less access to quality healthcare. One 2014 federal study of 1,800 primary care providers and specialists participating in Medicaid managed care plans showed that more than half couldn’t offer appointments to enrollees. (Some 35 percent weren’t even at the location listed by the plan).

Why are we doing this when the current system’s costs per enrollee are falling? When it’s finally in the black and projected to stay there? When Medicaid managed care has such a spotty record in other states?

The answer from the General Assembly’s privatizers: Because we’re tired of dealing with Medicaid budget shortfalls, some $2 billion over the past four years. So, in the next four years, the state will move from a fee-for-service model to paying a flat fee per patient. Private firms and healthcare provider-led groups will compete, but who expects care-conscious doctors to win bidding wars against cost-cutting CEOs?

As the House moved to approve the change Tuesday, Rep. Nelson Dollar, R-Wake, raised two important points.

“We need reform in North Carolina that is based on caring for our citizens and not for a group of stockholders,” Dollar said. “Why more than double the administrative cost we’re currently paying by adding middlemen between our doctors and patients? I just don’t see where the value is.”

For lawmakers weary of the messiness of Medicaid budget forecasting, the value lies in reducing a complex problem to an easy answer – just privatize it.

Federal officials must approve this plan. They’ve been moving toward creating quality ratings and profit guidelines for Medicaid HMOs.

North Carolina’s 1.8 million Medicaid recipients will have to hope Washington does a better job of protecting their interests than Raleigh has.

This story was originally published September 23, 2015 at 5:32 PM with the headline "How lawmakers in Raleigh are putting 1.8 million people at risk."