In announcing his plan to privatize North Carolina’s award-winning Medicaid program, Community Care of NC, Governor Pat McCrory laid out five key reasons that in his view privatization is necessary. The only problem? None of them hold up under the even the most cursory scrutiny. I’ll thoroughly debunk each in turn:
McCrory’s #1 claim why NC should privatize: “[NC Medicaid Community Care] does not focus on measuring and improving overall health outcomes for recipients”
Community Care is proven to provide much better access to health care services that results in measurable improvements in health shown through changes in health service use.
For example, an exhaustive study last year of how children and others on NC Medicaid are using health services found that children with asthma enrolled in Community Care spent much less time admitted to the hospital and in the emergency room than children not enrolled. At the same time these children with asthma spent more time in their family doctor’s office and getting medication to manage their condition. This is the very definition of better care.
And Community Care doesn’t stop there. CCNC has a detailed process for measuring quality of care delivered by providers statewide and encouraging better quality– the “Quality Measurement and Feedback” program.
McCrory’s #2 claim why NC should privatize: “[NC Medicaid Community Care] lacks a culture of customer service and operates in silos, making it difficult for recipients to know where to go to receive the right care”
Governor McCrory might want to take a look at the actual Medicaid card sent to people on Medicaid when they sign up. It includes the name, address and phone number of the Medicaid recipient’s family doctor or health practice printed right on the card. You don’t get much easier direction as to who to call first when you get sick than that.
McCrory’s #3 claim why NC should privatize: “[NC Medicaid Community Care] does not take a comprehensive approach to care, separating physical health from mental health and substance abuse”
In fact, Community Care of NC does enroll members with serious chronic mental health problems. And an independent assessment from a private national consulting firm, Treo Solutions, found that patients with serious mental health needs enrolled in Community Care experienced significantly less preventable admissions and readmissions to the hospital than patients not enrolled. Preventing unnecessary hospital admission and readmission is a common indicator of care quality.
McCrory’s #4 claim why NC should privatize: “[NC Medicaid Community Care] makes it difficult for doctors and other healthcare providers to participate because of a complex system with uncertainty, high costs and burdensome paperwork”
According to a recent study in the respected national journal Health Affairs, 76.4% of physicians in NC actively accept new Medicaid patients compared to a national average of 69.4%. In Florida, where schemes to shift people on Medicaid into private managed care companies have been operating for years, the rate of physician acceptance of Medicaid is only 59.1%. The vast majority of physicians in North Carolina are actively accepting new Medicaid patients.
McCrory’s #5 claim why NC should privatize: “[NC Medicaid Community Care] experiences unpredictable cost overruns because of weak cost controls, high administrative costs and a lack of adequate oversight as evidenced by a recent audit of the program. Such volatility puts at risk funding for other priorities like education and road repair.”
It’s hard to bring a program in under budget if the program budget being set by the General Assembly is so unrealistic that it could never be met. As former NC Department of Health and Human Services Secretary (and former NC Republican legislator) pointed out multiple times to the General Assembly about the Medicaid budget demanded by legislators: “It’s just really going to be next to impossible to achieve this budget and I’m not sure where the legislature will go with that.” “[These] aggressive budget cuts mandated by the General Assembly’s budget are unreasonable and unobtainable.”
One other fact. NC Medicaid has the lowest spending growth in the nation. We should be proud of our award-winning program and not planning to sell it off to private managed care companies.