People from rural communities, in particular, worry about what effect not expanding Medicaid will have on access to health care.
By Hyun Namkoong
Hundreds of doctors in white coats, health care advocates and supporters of the North Carolina NAACP gathered at the state General Assembly to ask lawmakers for Medicaid expansion Wednesday.
Last March, the state decided not to expand Medicaid as allowed for under the Affordable Care Act, leaving an estimated 318,710 uninsured North Carolinians in a “coverage gap” in which they don’t qualify for Medicaid but can’t afford to buy insurance on the online health insurance exchange.
Similar gaps in coverage exist in states that opted out of an expansion of Medicaid under the ACA that would have extended eligibility to low-income adults who have historically been excluded from receiving Medicaid.
“We want to be advocates for that [underserved] population and ensure that we can provide high-quality care, and hopefully lower-cost as well,” said Henry Colangelo, a fourth-year medical student from UNC-Chapel Hill who came to the legislature with some of his classmates.
One of those fellow students, Laura Cone, said that Medicaid and Community Care North Carolina have been “really inspiring to me as a medical student. We start turning our backs on what’s happening in our state … and we might not be going in the right direction.”
NC Medicaid a model
Gov. Pat McCrory has repeatedly called Medicaid a “broken system” that must first be reformed before it can be expanded.
But many medical students, physicians and health-policy experts say North Carolina’s Medicaid system is one that many states in the nation look to as a model. Community Care of North Carolina is the state’s Medicaid management program recognized by many experts as contributing to the state’s low year-over-year growth in Medicaid spending.
Recently, officials in Alabama asked CCNC to help develop that state’s patient-centered medical home Medicaid plan.
“CCNC is the leader, and many states are copying what we have done,” said Cleveland Piggott, another medical student from UNC-Chapel Hill.
The Senate version of the budget, which passed last week, eliminates CCNC.
“We were disheartened a little bit and disappointed in the Senate budget,” Piggott said.
The Senate version of the budget also included changes to Medicaid eligibility for many elder beneficiaries and many with disabilities, and called for reductions in Medicaid reimbursements for providers.
“I’m concerned about the changes in Medicaid that are being proposed and how that will affect families and children throughout the state,” said Kaye McGinty, a child and adolescent psychiatrist from Greenville.
Rural hospitals are hurting
Standing next to William Barber, president of the state chapter of the NAACP, and House minority leader Rep. Larry Hall (D-Durham) was Adam O’Neal, the mayor of Belhaven and a Republican, who had come to Raleigh to push for Medicaid expansion in the state.
“Without Medicaid expansion, the reimbursements are falling,” O’Neal said, “and hospitals like the one in my hometown are on the brink of possibly even closing.”
The state chapter of the NAACP filed a Title VI complaint a few months ago that prevented the closure of the Pungo District Hospital, located in Belhaven, which serves some 25,000 residents of Beaufort and Hyde counties.
“You can’t let hospitals close and people die to prove a point,” O’Neal said after drawing laughter from the crowd for saying that Medicaid expansion is one of the few things he and Barber agree on.
An agreement between the town of Belhaven, the NAACP and Vidant Health led to a public-private partnership to determine the future course of the hospital. The ownership and responsibilities of the hospital have yet to be finalized, O’Neal said, acknowledging the difficulty of creating a model of care for rural communities.
“We’re having to deal with delays and people trying to undermine us in different ways,” he said. “We’re moving forward towards trying to develop a rural health care model that can be used across the country.”
Rural hospitals in the state and nationwide have been struggling to stay afloat and keep up with the need to modernize equipment and administration.
“Treating people who live in rural areas is even harder because of all the barriers and access-to-care problems,” McGinty said.
No to HMOs
Many of the doctors gathered also sported bright-yellow stickers emblazoned with “HMO” and a thick-black line slashed through it to demonstrate their dissatisfaction with health maintenance organizations.
“There’s no incentive to deliver a higher quality of care [with HMOs],” said Garrett Franklin, a family-medicine resident in Wake Forest. “They do show they can cut costs, but they do this at the expense of the patient by cutting enrollment and cutting benefits.”
Some also warned against HMOs coming in from outside of North Carolina, diverting money away from the state.
“There’s a lot of concerns that the legislature may promote a model where companies from around the country come here and start a managed care organization, take the profits and run,” McGinty said.
“What we’re asking for is that North Carolina medicine and health care be provided by North Carolina practitioners and funded through North Carolina, and the money stay in North Carolina,” she said.
Physicians around the state have been increasingly supportive of accountable care organizations rather than HMOs. ACOs aim to coordinate care between providers and hospitals, avoid duplications or unnecessary services for patients and meet quality benchmarks to share in savings from reduced hospital visits and clinic usage.
“ACO is a great model, obviously not perfect. It provides a lot of incentives to doctors like me to provide high-quality care,” Franklin said.
“It drives down the cost. [It’s] less people in our hospitals, less people in our emergency room.”