by William Crawford

Gov. Pat McCrory and his legislative brethren are committing a vicious assault against the hardworking, low-income people of North Carolina. Their decision not to expand Medicaid amounts to a felonious attack against people who choose to work.

It denies healthcare to some of our most deserving citizens. This brutal attack against those without health insurance is a prime example of adherence to partisan ideology trumping any real concern for citizens.

Gov. McCrory has repeatedly described the Medicaid program as “broken.” His attacks on Medicaid amount to a smokescreen designed to give momentum to Republican plans to cut the program and privatize services by hiring out-of-state companies to run them.

No creditable evidence suggests that our Medicaid program is more poorly run than in other states. North Carolina’s administrative costs are in line with the national average. Our menu of optional services is indeed a beacon among Southeastern states.

Yes, the overall costs of the program have soared in recent years. This is mostly a result of the Great Recession and our high unemployment rate. More people are poor now, and they qualify for Medicaid.

Yes, there have been problems at the Department of Health and Human Services, which oversees Medicaid. Those struggles include outdated computer systems, constant budget cuts adversely impacting staff and morale, and inept partisan leadership at the top. Those problems are clearly caused by people, not by the Medicaid program.

Let’s take a closer look at the people who the Jones Street Gang are keeping off Medicaid. These citizens are mostly wage-earners with incomes ranging from $15,400 for a single person up to $31,800 for a family of four. Their incomes are very low but too high to qualify for Medicaid now.

Some of them can only get part-time work from their employers. Most cannot even afford to pay the reduced premiums necessary to access Obamacare. They are making just enough to get screwed.

The decision not to expand Medicaid is costing our state billions of dollars each year. It is truly an economic catastrophe. Here’s why: The expansion would gradually create 25,000 new jobs in healthcare and related fields. These jobs are now lost unless the expansion is implemented.

Our hospitals are also writing off millions of dollars each year for unpaid services to uninsured patients who could be covered by the Medicaid expansion. With expansion, our hospitals could be paid.

Federal policies are severely penalizing hospitals because the state failed to expand Medicaid. The larger hospitals that provide substantial uncompensated care to the poor are no longer eligible for federal supplements for indigent care. They are losing more than $500 million this year alone.

Every North Carolina taxpayer is hurt. Taxes that we pay into the federal treasury are now being sent to other states in the form of shifted Medicaid payments. In an important sense every taxpayer in North Carolina is being cheated. These lost funds already total billions.

The General Assembly is coming back into special session in November to deal with Medicaid. This provides a golden opportunity to end the brutal assault against the working poor and the broader state economy. McCrory, Phil Berger and Thom Tillis should do the following:

Concentrate Medicaid program reform on revising the provider payment structure, which now strongly favors the quantity of services over producing quality and positive patient outcomes. This is where real efficiency and program savings can be found.

Abandon any plan to create a new agency to oversee Medicaid. Instead emphasize rebuilding DHHS with modern computer systems, adequate staffing and professional leadership to replace political punks.

Privatizing of administrative functions should be minimized. The profit motive inherently breeds increased fraud and shortcuts that hurt recipients. However, some forms of limited privatization may be desirable for specific areas not easily handled by government.

Move forward quickly to expand Medicaid whereby the federal government pays for 90 percent of the cost. Some 250,000 uninsured, low-income wage earners might then gain health coverage.

The state should apply for expedited federal waivers needed to accomplish Medicaid expansion. Many innovations are available which have been utilized by other Republican-led states such as Arkansas. The expansion might even be phased in over three years by ascending income levels to create a more orderly fiscal transition. Expansion should begin no later than October 2015.

North Carolinians want a more moderate, humane approach to meet the needs of the working poor. They also want a Medicaid program run by Tar Heels, not private contractors looking to take profits made here back to other states.

The Republicans should stop piling on the defenseless. Instead they should craft moderate, commonsense solutions for the problem of the still uninsured. This recently elected majority has had its partisan fun. Now it is time to do some real responsible governing.

William C. Crawford is a social worker, writer, and photographer living in Winston-Salem. He has 40 years of experience working in Medicaid. He formerly taught policy at the UNC School of Social Work. He can be reached at [email protected]

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