'Medicaid reform' is a code for privatization

The N.C. Department of Health and Human Services will hold a public hearing from 2-4 p.m. Thursday in the Emerald Ballroom of the Greenville Convention Center on its proposed plan for Medicaid reform. The hearing will present an opportunity to ask that Medicaid expansion be included in the reform plan.

It likely will require divine intervention for Gov. Pat McCrory and the Republican-held General Assembly to do that, but greater things have been accomplished that way.

To assure support for his 2012 election, McCrory committed to cut taxes — 100 percent if possible — particularly for the state’s wealthiest individuals and corporations. Medicaid is an expense, and there can be none of that.

The new governor had not developed an effective plan for skirting the Medicaid expansion issue, which under the Affordable Care Act pledges 100 percent federal support the first two years of expansion before settling at 90 percent thereafter. The expectation is to get more poor people healthier by raising the eligibility for Medicaid to 138 percent of the federal poverty level — adding more than 500,000 North Carolina residents — and keep them that way longer to reverse the permanent drain on the national and state treasuries.

The 10 percent state cost is a deal killer, though, regardless of the lives it would save and the resultant lift to the state’s economy.

Gov. McCrory knew then, as he does now, that not expanding Medicaid is wrong medically, economically and morally, especially in North Carolina, where the Medicaid management system has been a national model of efficiency and effectiveness. But being politically committed to opposing expansion, his communications team gave him a spin line to toss to the media.

“Medicaid is broken,” McCrory said in 2013. “I want to fix it, not expand it.”

When asked if the governor had calculated the impact of rejecting more than half a million people from participation in health care, the governor’s press aide, Ricky Diaz, replied, ”Those people (the sick and poor) are not in the governor’s plans.”

They still are not in the governor’s plans.

In September 2015, North Carolina passed a law to “reform” Medicaid services in the state. It proposes to create a plan to “help doctors and other health care professionals focus even more on quality care and making patients healthier, while controlling costs to taxpayers.” Being a conservative plan, this will be achieved through competition. Doctor groups will compete with private money managers. Care to bet who wins?

The reform that the General Assembly’s Republican majority is seeking is to eventually have complete privatization of health care in North Carolina and eliminate the state’s administrative expense. All the rest is smoke and mirrors. Very well-crafted smoke and mirrors, but smoke and mirrors just the same.