Medicaid: Is this reform or a sweet deal for big insurance?
Published September 27, 2015
Editorial by Fayetteville Observer, September 27, 2015.
We've long believed that the movement in Raleigh to reform the state's Medicaid program was an effort to fix something that wasn't broken.
But after the final debate on the issue in the General Assembly last week, we're seeing a bigger picture: It's not about Medicaid. It's about handing the program over to for-profit insurance companies that have spent lavishly on lobbying and political donations to get what they want.
We know this because the Republican lawmaker who best understands Medicaid told us so. He told his colleagues too, just before the House voted to approve the unnecessary overhaul.
Rep. Nelson Dollar of Cary, senior chairman of the House Appropriations Committee, took the floor Tuesday and told his colleagues the truth:
The recurring problems the state has had with Medicaid weren't the fault of any of the providers or participants. The problem was the General Assembly, which under-budgeted for the state-federal health-insurance program serving the poor, disabled, elderly and children.
Under the state's current Medicaid manager, Community Care of North Carolina - a physician-run program - Medicaid claims costs have declined over the past five years, despite adding more than 200,000 recipients. At the end of the past two fiscal years, the program had a budget surplus - more than $130 million in the black this year.
Whatever the current system's problems might be, the cure will likely be worse. "Insurance HMOs have failed repeatedly in North Carolina," Dollar said, citing experience with the mental health system and in the State Health Plan in the 1980s and '90s.
So as a reward for its success - creating a program many other states are copying because their privatized plans have failed - Community Care is getting the boot and private insurance companies are being invited in. Once again, we're getting the best government money can buy.
But that's not the end of the saga. It may be years before the insurance companies take over Medicaid here, because the new plan needs to pass federal muster. The feds pay the biggest share of Medicaid costs and have a say in how the program is run.
Given the hard evidence of savings under the present Medicaid administrators - and the failure of this state to participate in the expanded Medicaid program that's part of the Affordable Care Act - federal approval may be difficult to achieve.
And that would be the best outcome for all of us - including the taxpayers.
