Medicaid expansion possible in NC

Gov. Pat McCrory and state legislators have repeatedly refused to expand North Carolina’s Medicaid program under the Affordable Care Act, citing hundreds of millions of dollars in cost overruns.

But at a state legislative committee meeting Sept. 17, the head of the Department of Health and Human Services said the agency might consider pushing for expansion.

“We are at a point where we have an ability now to evaluate options for the state,” said Dr. Aldona Wos , secretary of the department, at the meeting .

While the N.C. General Assembly has the power to expand Medicaid, Wos said the department plans to present expansion options to McCrory.

Jennifer James, a spokeswoman for UNC Health Care and UNC School of Medicine, said in an email the hospital system provides more than $300 million in uncompensated care — not covered by insurance — each year.

She said state-supported Medicaid would allow UNC hospitals to do more for the thousands of patients who depend on the program.

“Our state’s academic medical centers, including UNC Hospitals, represent about half of the Medicaid care provided in North Carolina,” she said.

She estimated UNC Health Care is losing between $75 to $85 million in annual revenue because the state has not expanded Medicaid.

But Katherine Restrepo , the health and human services policy analyst at the right-leaning John Locke Foundation, said the organization believes Medicaid expansion would be costly and negative.

Medicaid cost overruns totaled nearly $500 million by the end of last year.

“There are just so many inefficiencies in the program,” Restrepo said. “And I think that if there is more budget predictability, it will hold the government more accountable for how to manage Medicaid populations and provide the best healthcare to those currently in the system.”

This summer, lawmakers called for Medicaid to be taken out of DHHS, in part because of budget mismanagement.

Still, Wos said significant progress has been made in restructuring the department, reforming the Medicaid program and balancing its budget.

"We are on the path of stability and sustainability, and this entire direction we are on would be undermined if the Medicaid program was removed from the department,” Wos said.

Instead of expansion, Restrepo said state lawmakers should focus on patient outcomes rather than the exact number insured.

“The question is, ‘Does having insurance mean access to health care?’ There’s a big distinction between the two,” Restrepo said.

Julie Henry, a spokeswoman for the N.C. Hospitals Association, said she is optimistic the state will ultimately find the best solution.

She said expansion and reform of Medicaid would improve access to care for low-income citizens because it would encourage them to seek preventative care and not wind up in an emergency room.

“Often those are individuals who can’t afford to pay for that kind of expensive care,” Henry said.

“That is a drain on taxpayers, it’s a drain on hospitals, it’s a drain on insurance companies. And so if we can figure out how to get people in the system earlier, then we all end up benefitting in the long run.”

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