Health Care Act

Managed care groups push North Carolina Medicaid change

Originally published Feb. 20, 2015.

A coalition of insurance companies and managed care providers recently launched N.C. Medicaid Choice to lobby for change in the way the state administers the program.

"The Coalition supports legislation that shifts financial risk away from taxpayers by allowing traditional managed care plans, as well as plans offered by health care providers, to compete in the North Carolina Medicaid market," says an announcement posted Feb. 10.

Aetna, Amerigroup, AmeriHealth Caritas, UnitedHealth Group and WellCare are the founding members. They've hired Taylor Griffin, a political consultant who ran for Congress in the 2014 GOP primary, as point person for the campaign. Griffin, an Appalachian State alum, worked for Sen. Jesse Helms and President George W. Bush before making his own bid for office (he lost to Walter Jones).

Republican leaders of the state House and Senate have talked about the need to reform Medicaid, which has a history of cost overruns, but haven't agreed on a strategy. Griffin said Thursday his coalition supports the Medicaid Modernization bill, which would let groups like the ones he represents compete with accountable care organizations run by doctors or hospital, over the Partnership for a Healthy North Carolina bill that turns Medicaid over to only the provider-led groups.

Both involve the state paying a per-patient fee to groups that take the responsibility for providing care and controlling costs; they turn profit if they come in under budget or take the loss if they run over. Both, says Griffin, provide incentives to push the kind of preventive care that not only cuts costs but improves lives – for instance, prenatal care, timely screenings and healthy lifestyle changes. Allowing the established for-profit firms to compete will lead to bigger savings and a quicker roll-out, Griffin said.

A news analysis that ran in the Observer this week noted that in some Republican circles, "Medicaid reform" has become a euphemism for taking federal "Obamacare" money to expand coverage for low-income adults. Griffin said his group is taking no stand on Medicaid expansion in North Carolina. For them, reform is about fixing with the system that's in place, not making more people eligible.