Mooresville Tribune
(NC)
April 5, 2018
North Carolina and the other 17 states that have not
expanded their Medicaid program are running out of excuses from an analytical
standpoint, according to a leading health-care law expert.
Mark Hall, a law and public health professor at Wake
Forest University, released last week a study titled "Do states regret
expanding Medicaid?"
Medicaid enrollment in N.C. has climbed from 1.75 million
in July 2014 to a projected 2.14 million on June 30 - representing about 21
percent of the state population - according to the N.C. Department of Health
and Human Services.
The increase was spurred in large part by applicants for
the federal health insurance exchange being determined as eligible for Medicaid
coverage.
Another 500,000 North Carolinians could become eligible
with Medicaid expansion tied to federal funding initiatives.
Hall's latest work on the subject is in response, in part,
to what he called increasing evidence that Medicaid expansion costs have proven
to be negligible for the 31 expansion states.
In January 2016, Hall released a study that weighed the
pros and cons of expanding the state Medicaid program. Hall and researcher
Edwin Shoaf came down in favor of expansion, saying the time has come "for
an honest dialogue about the costs and benefits of expanding Medicaid."
"With the Affordable Care Act is in its fifth year of
full expansion, we now have an established track record in the expanding states
to help estimate what the actual costs of expansion will be" to the 18
states, Hall said.
"This issue brief reviews that evidence, and
evaluates continuing claims by Medicaid opponents that expansion is a 'proven
disaster' for state budgets."
The main argument against Medicaid expansion, shared by
several N.C. Republican legislators leaders including Speaker pro tem Phil
Berger, R-Rockingham, is that the federal government may not fulfill its pledge
of covering 90 percent of the administrative costs of expansion.
They say they don't want states to be unnecessarily
vulnerable to picking up more than 10 percent of the costs.
"The strong balance of objective evidence indicates
that actual costs to states so far from expanding Medicaid are negligible or
minor, and that states across the political spectrum do not regret their
decisions to expand Medicaid," Hall said.
For example, Hall cites reports that several red or purple
states - Arkansas, Indiana, Kentucky, Louisiana, Michigan, Montana, New Mexico,
Ohio and West Virginia - "have actually reduced, not increased, state
spending as a result of expansion."
Part of the spending decrease comes from
smaller-than-expected enrollment in recent years, particularly in Indiana,
North Dakota and Ohio.
"None of those states that had legislative
'triggers,' allowing them to roll back expansion if projected costs turn out to
be seriously wrong, have felt the need to pull the plug on expansion,"
Hall said.
Expansion
Expanding North Carolina's Medicaid program has been a
hot-button issue since the possibility emerged in 2009.
State Medicaid expenditures have been about $14 billion
annually in recent years, with the program projected to operate under budget
for the fourth consecutive fiscal year.
A study by Avalere Health, released in November,
determined that North Carolina will lose out on $13 billion in federal Medicaid
funding over the next decade by not expanding.
Dr. Mandy Cohen, the state's health secretary, told
legislators March 13 that North Carolina could learn within weeks whether it
will gain Trump administration approval for its extensive Medicaid waiver
reform request.
Some Republican legislative leaders consider expansion a
non-starter even though Rep. Donny Lambeth, R-Forsyth, introduced in 2017 House
Bill 662 that would expand the program with a work requirement for some
recipients.
The Indiana and Kentucky legislatures recently approved
expansion with that standard after the federal Centers for Medicare and
Medicaid Services signed off on the change Jan. 11.
"Claims are not well founded that Medicaid expansion
will cost states considerably more than what objective analysts project,"
Hall said.
"Instead, those claims are based on sources that are
either incomplete, inaccurate, misleading, or out of date in various ways.
"The probable costs appear to be quite low in
comparison with the economic and public health benefits of expansion," he
said.
Waiver request
A federal Medicaid waiver request was submitted by the
McCrory administration in June 2016, which was amended Nov. 20 by the Cooper
administration.
"We are one of the few states in that category with a
comprehensive Medicaid waiver application," Cohen said. "The other
states that have had their waiver approved pursued a very narrow slice with the
work requirement."
Lambeth said HB662, titled Carolina Cares, would work
"more like an insurance product for those working who can pay a portion of
the cost, and the benefits and coverage are built around preventive and
wellness care."
For example, participants would have to follow protocols
for routine physicals and screenings to improve their health if they have such
conditions as diabetes, obesity, etc.
Even though Lambeth said HB 662 "does not require any
state funds, but in fact saves the state money as demonstrated by fiscal staff
in Raleigh," his bill has not emerged from committee.
Lambeth said last week it may take until 2019 for HB662 to
get another thorough review given that the 2018 short session is expected to
focus foremost on state budget adjustments.
Lambeth said Hall's study could be helpful for potential
revisions to his bill.
"It is helpful to track results in other states, as
well to learn from others," Lambeth said.
"This report helps me continue to frame the issues
for my legislative colleagues and work to move it forward at the right
time."
Sen. Joyce Krawiec, R-Forsyth, said she will take special
interest in Hall's study since "there appears to be some conflicting
reports on results from some states in prior studies."
"I'm anxious to examine it thoroughly. We certainly
want to take every opportunity that we have to improve health care to our
neediest population."
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