Expand insurance coverage without expanding Medicaid
Thursday, March 21, 2019
The state treasurer and the N.C. Healthcare Association can't reach consensus over how to pay for health insurance for state employees. The governor and some legislative leaders are advocating Medicaid expansion to cover an additional 600,000 people.
The debate, proposals, and arguments have focused on the high cost of health care, who will pay, and ways to shift costs. I think they're focusing on the wrong things.
Everyone involved in the discussion seems to accept the high cost of health care, which affects and drives up the cost of insurance. The debate is how or who will pay, but not about the root of the problem, which is how to lower the high costs.
Obamacare was supposed to make health care more affordable. It hasn't. To my dismay, many North Carolinians seem to accept high costs as the new normal. We shouldn't. Costly medical care drives up the cost of insurance. That doesn't help anyone. It helps neither those who have insurance nor those who don't.
Instead of looking for ways to lower costs for everyone through free-market reforms, Gov. Roy Cooper and some legislative leaders are not only doubling down on the high-cost status quo, but they also want to expand it.
Medicaid expansion would add more than 600,000 adults caught in an insurance gap. That might sound good, but focusing on adding more people to a fragile government program undergoing massive change is the wrong approach. Medicaid is more an issue of government trying to solve a problem government created. We should work to lower the costs. When we do that, those in the insurance gap will have access to affordable insurance coverage.
Here's what we know about Medicaid expansion's failed promise: Expansion states are seeing enrollment numbers way over what was predicted, cost overruns that threaten the stability of state budgets, and less access to care.
We don't have to join the government spiral. When we reduce the cost of health care, and as health care costs go down, the cost of health insurance will go down, too, enabling more North Carolinians to afford the health insurance they want and access the health care they need. All without depending on a government one-size-fits-all program. Here's how we change the trajectory with a package of reforms focused on individualized, innovative ideas driven by free markets and personal choice:
■ Repeal Certificate-of-Need laws.
■ Encourage the use of telemedicine.
■ Expand the scope of practice for providers, allowing them to offer services they've been trained to provide.
■ Amend supervisory requirements to allow experienced practitioners to provide care where appropriate.
■ Introduce dental therapy as a way to extend dental care cost effectively.
■ Encourage direct primary care practices to continue to grow and flourish.
■ Allow and expand small business health plans to offer more flexibility and customization of health insurance plans.
■ Adopt a rule to require doctors and hospitals to disclose the rates they negotiate with insurance companies.
■ Establish a foundation to offer grants or low-interest loans for expansion of medical services, assistance with medical training costs, and housing and personal needs for mid-level providers in rural areas. Use a percentage of hospital nonprofit property, income and sales tax relief to fund the foundation. Allow other businesses or philanthropies to contribute to the fund.
■ Lead the nation and region by establishing a Southeast compact to offer health insurance plans across state lines.
■ Encourage competition, discourage monopolies and market consolidation in the hospital, insurance and pharmaceutical industries.
Our reform plan must not leave existing Medicaid recipients stranded. We must ensure Medicaid works better and ensure it provides a safety net to those it was always intended to help. About 12,000 current Medicaid recipients are on waiting lists — some five to 10 years long — to receive support services, the ninth-highest in the country. These services are for people struggling with mental illnesses, opioid addiction, or severely disabled children.
Rather than adding 600,000 working-age adults onto a fragile system, let's allocate the money to reduce the waiting lists and get these people the help they need.
Becki Gray is senior vice president of the John Locke Foundation.