Medicaid issue tough, but needs attention, legislators say
By Steve Herring
Published in News on August 2, 2015 1:50 AM
There was agreement Friday by Wayne County's five-member legislative delegation that Medicaid reform is perhaps the thorniest issue they face.
They agreed as well that it could keep them in Raleigh well past the time they had hoped to have adjourned.
There was less agreement on how best to address an issue that has haunted the state for years.
"I believe that Medicaid will keep us in Raleigh until we have a plan that has been agreed to by the Senate, and by the House and by the governor because we don't face a bigger problem than Medicaid in my view," said Sen. Louis Pate. "I hope we have the moral vision to stay in Raleigh until Medicaid is reformed."
The reform should improve efficiency in delivering needed health care to patients while improving funding predictability, Pate said.
The legislators were asked about those and other issues during Friday morning's legislative update breakfast at Lane Tree Golf Club.
Rep. John Bell said there appears to be a major "hanging point" between how the House and Senate approach the reform.
One problem is the "antiquated fee for service" model," said Pate.
Every time someone goes to a provider a fee is due, he said, adding the system is not efficient. Pate suggested a per-member per-month rate in which the health care providers are paid for keeping people healthy, eliminate extra trips to the provider and help patients with a healthier lifestyle. The provider would receive the fee whether the person went to the provider or not. That can be used to help cover those who are chronic visitors to the doctor's office, Pate said.
Medicaid is funded totally through taxpayers' dollars -- one third from the state and the other two thirds from the federal government.
"The basic problem with Medicaid -- there are several -- but North Carolina's Medicaid program is growing faster than the taxpayers' ability to fund it," Pate said.
If the program is not changed the state will need $789 million over the next two years to pay for it, he said.
The state also has been dealing with a great amount of uncertainty in the Medicaid budget in any given year because of income levels with people quickly coming in and out of the program, he said.
Over the past two budgets the state has had to fill Medicaid shortfalls of $2 billion, he said. That money was therefore not available for education, infrastructure and other needs, he noted.
The shortfall continues despite two trends working in the state's favors, Pate said. One is that the enrollment growth has primarily been in lower-cost enrollees -- the non-aged, the non-blind and the non-disabled, compared to the national trends. Also, since 2008, the Legislature has initiated more aggressive cost control measures.
However, the state cannot count on either trend continuing forever, Pate said.
"One of the main problems, and I believe I said it here last year, is that the first place that they go for medical care is the emergency room at the hospital, which is the highest price place to go for medical care," Pate said. "We have got to have those patients aligned with a medical provider so that their problem does not get out of hand, and they have to show up at an emergency room."
Sen. Don Davis agreed Medicaid is the biggest issue lawmakers face and that something must be done.
"I think it must be patient and outcome driven," he said. "I think docs must be highly engaged in that process -- those who are out in the community, working with patients. That is absolutely critical to reform."
But there is much more at stake, he said.
"I don't know that we can have a serious conversation about reform without truly, truly talking about expansion," Davis said. "We have heard comments earlier, but I am going to give a different perspective on expansion of Medicaid. Medical experts say an estimated 1,000 North Carolinians die every year because we have not expanded Medicaid in North Carolina."
That failure to expand cost the state $2.7 billion in 2014 and $3.3 billion this year, Davis said.
"We can play games all that we want, and we can shove it off as government this and that, but at some point we need to have a real conversation about this. I will end by simply saying this, I have heard all kind of things -- we have to reform before we expand.
"This has gone on too long, way too long for us to sit down and have a really serious conversation," he said. "I will end by simply saying this: We have the sophistication to reform and expand. Some are still saying repeal and replace."
Medicaid is an example of what government is not good at doing, said Rep. Jimmy Dixon. He noted that it dates back to the 1960s and President Lyndon Johnson's "War on Poverty." The war has failed, Dixon said, and government needs to get out of the way.