By Rose Hoban
Michael Stoiko drove up from Wilmington on Tuesday evening with several coworkers so he could speak for two minutes.
By the time Stoiko, a pediatric critical care physician, finished speaking to about 250 people attending a public hearing on North Carolina’s Medicaid reform plan, you could hear a pin drop.
That’s because he told a heart wrenching tale of unnecessary death.
“I again recently had the experience of looking down at a beautiful 5-year-old girl with fixed and dilated pupils, because she was brain dead, because she had asthma,” he said.
Stoiko works with Coastal Children’s Services, a practice which provides subspecialty care at hospitals throughout the southeastern part of the state. He said this child had not had regular access to primary care.
“She arrived in our ED brain dead after arresting at home,” he continued.
“That’s maybe the fourth or fifth hundred child I’ve seen die of a completely preventable cause because they did not have access to primary care, and they did not have access to some specialty care,” Stoiko said. “I’m getting kinda tired of that.”
Forty-two people who spoke at the McKimmon Center on the N.C. State University campus for the listening session hosted by the Department of Health and Human Services, at least 30 of them directly told HHS Secretary Mandy Cohen that the state’s Medicaid overhaul should include expanding Medicaid.
Many of the physicians’ stories were about patients they saw too late.
“Throughout my career, I saw patients with heart failure, stroke, end-stage renal disease, mostly from untreated hypertension, diabetes or high cholesterol,” said James Foster, a retired cardiologist who practiced in Wake County and also taught at UNC Chapel Hill.
“In many cases, they might have been prevented if they had been able to afford medical care, but now their lives were devastated,” Foster said of his patients who were ineligible for Medicaid coverage and were uninsured.
Cohen, Medicaid director Dave Richard and other DHHS staff heard from medical students, primary care physicians, the head of UNC Healthcare, volunteers and county health directors, all of whom had the same message: find a way to extend insurance to more people in the state.
But it’s not DHHS that will ultimately make that decision. A 2013 law leaves that decision in the General Assembly’s hands.
“I think the reason why it’s important we hear those comments is because you know there are members of the legislature that care about that,” said Richard. “I think what people have said to us here is that coverage is really important.”
Opioids, children at the forefront
Some of the strongest themes in Tuesday night’s meeting were around the impact of Medicaid on children.
“Medicaid is children’s health insurance,” said Theresa Flynn, a pediatrician in Wake County who sees mostly low income children. She pointed out that children make up the majority of the enrollees in Medicaid, but account for less than a quarter of the costs.
Several speakers noted that social issues such as poor housing, poverty, diet or access to transportation are big players in health outcomes. In some parts of the state, the opioid epidemic is affecting children’s health.
Stoiko’s co-worker, Elizabeth Harris, noted that in the neonatal intensive care unit at the Wilmington hospital where they work, 15 to 20 percent of the babies are in withdrawal from opioids they were exposed to in utero.
“And in Lumberton, it’s 30 to 50 percent,” she added.
About three-quarters of Coastal Children’s Services patients are children Harris told the crowd.
Afterward, Cohen noted how children’s health predominated the issues raised at this meeting, while services for people with intellectual or developmental disabilities was the big issue in Greensboro and dental care issues took precedence in Greenville. She was unable to attend the Asheville meeting which took place last week.
In all the meetings this month, however, Medicaid expansion was the common thread.
“This process has been very helpful in understanding where folks are and where consensus is developing,” Cohen said.