GREENSBORO — State Health and Human Services Secretary Dr. Mandy Cohen got an earful Monday night as she launched a statewide tour to solicit opinions about Medicaid reform.
Several dozen medical providers and association officials, patients, and parents of children on Medicaid attended the first in a planned series of town hall forums. As more than 30 speakers took the podium, the nearly two-hour session oscillated between political rally and heart-tugging pleas for help.
A majority of the speakers lobbied for Medicaid expansion and against using for-profit managed care organizations to create networks of providers to deliver Medicaid services. Many supported integrating mental health and substance abuse treatment into primary care.
Some expressed concerns about the fate of independent physicians, who treat a large portion of Medicaid recipients. Others encouraged greater use of health savings accounts to lower lower costs. A few pushed for direct primary care, which lowers costs because those doctors don’t accept insurance, eliminating overhead.
The process began about a year ago when the state asked the federal Centers for Medicare and Medicaid Services for a waiver to reform the Medicaid delivery system.
The General Assembly passed legislation in 2015 to place the government insurance program for the poor, children, aged, blind and disabled populations under for-profit managed care organizations. The state would be divided into regions. Entities made up of hospitals and doctors would submit bids to run regional networks. Three statewide managed care networks operated by large insurance companies would be created.
That waiver is awaiting review, Cohen said. She said the wait allows time for public comment, along with the chance to request changes in the waiver application.
Cohen acknowledged that reforms would be difficult, and many people fear the uncertainty that comes with change.
“Our current president is recognizing how complex health care is,” Cohen said to a ripple of laughs.
“We support Gov. [Roy] Cooper’s agencies seeking feedback from the people they serve, but lawmakers, DHHS, and numerous other stakeholders spent years developing, then passing, a comprehensive plan for Medicaid reform,” Shelly Carver, a spokeswoman for Senate leader Phil Berger, R-Rockingham, told Carolina Journal on Tuesday.
“We hope the department’s focus is on getting that plan into place as quickly as possible so we can realize the goals of achieving greater budget sustainability, delivering the highest quality care, and fostering better health outcomes for North Carolinians,” Carver said.
Ken Lewis, executive director of the Pinehurst-based North Carolina Association of Health Plans, whose members include insurance companies, acknowledged misgivings remain about insurance company-led managed care organizations.
There are good and bad for-profit companies, just as there are good and bad nonprofits, he said.
“Managed care has come a long way, and the legislature is following what 39 other states have done, and that is trying to get some predictability in a program that is costly, and lacking in the quality measures,” Lewis said.
“It’s not all about the savings,” Lewis said.
But Christoph Diasio, a pediatrician in Southern Pines, said he opposes putting Medicaid under the supervision of private insurance companies. Science and experience have told him private insurance managed Medicaid isn’t a good fit for children.
Diasio, like other speakers, said having so many MCOs will be confusing and inefficient for providers who deal with patients in multiple regions. He rattled off a list of potential paperwork difficulties — from differences in how claims are filed, to how they’re coded, and what information must accompany them.
It would be harder to extract data analytics from so many providers as opposed to a single-payer state system and problematic for the MCOs to negotiate different deals at different rates in different regions, he said.
“Most hospitals, most providers period, have dealt with multiple carriers for a long time,” Lewis said.
Matthew Potter of Pfafftown, who receives Medicaid services for his cerebral palsy, got the loudest ovation of the night. He was among several speakers dealing with severe disability cases, and long waiting lists for unmet needs.
“We refuse to expand Medicaid even when it makes fiscal, financial, and ethical sense,” Potter said.
He said the state has two options: “We continue to let people suffer,” or “stop treating lives as bargaining chips for re-election. People are suffering, and people are dying, but I guess in year 2017 it doesn’t matter all that much to legislators in North Carolina because there are re-elections to win.”
Lewis said all of the companies his association represents have worked with challenging, emotional cases such as Potter’s situation. “They are unique to the individuals, they are not unique to the programs.”
Margaret Salinger, a practicing psychologist in Greensboro speaking in behalf of the state League of Women Voters, lobbied for Medicaid expansion. She said it would create 43,000 jobs, and bring $21 billion into the state.
Medicaid isn’t a jobs program, said Katherine Restrepo, director of health policy at the John Locke Foundation.
“It’s a public health insurance program for North Carolina’s most vulnerable citizens,” she said.
Because North Carolina decided not to expand Medicaid, speakers complained, money going to Washington is funding other states’ Medicaid programs. A Congressional Research Service report has debunked that claim.