FLATLINING Podcast Recap
EP #64 NC Medicaid Expansion
Ron and Matthew discussed the ongoing saga of Medicaid expansion in NC last week, with Ron providing insights to the mechanics of how Medicaid reimbursement rates differ than commercial payers but also about the benefits that expansion of this federal program can provide individuals and the state of N.C. in general.
Once N.C. passed a Medicaid expansion bill earlier in the year it was tied to the passing of the state budget which was expected to happen on July 1st. Unfortunately, budget negotiations dragged on through the summer and so other solutions to get Medicaid to pass were floated. One idea that started to take root was tying the expansion of Medicaid to an increase in legal gambling casinos in the state, but after Ron and Matthew recorded the podcast last week, this arrangement was dropped, and the Medicaid expansion was back in the budget bill.
To those not familiar to how physician reimbursement rates work, Ron explained that increasing Medicaid patients is not necessarily a good thing for a physician’s bottom line, explaining that Medicare and Medicaid offer a lower rate of reimbursement, sometimes as much as 50% of that as a commercial payer. He quickly pointed out that physicians approach their calling with eye toward compassion more often than a eye toward profits and for all of us that is good thing.
The people that are now going to be going on Medicaid, Ron said, are basically two groups, those that are now uninsured, who could not afford the subsidized insurance on the exchanges, which is good for these folks as it gets them health care coverage. The next group are the working families of four who are making less than $50,000 per year, which is the Medicaid threshold. Ron explained this group might be paying for insurance through an employer, but now they can switch to Medicaid which is free to them. This frees those funds they were paying for health insurance available for other expenses. Ron explained unlike the Affordable Care Act exchange, where a subscriber cannot be offered insurance form an employer, Medicaid does not have that restriction.
There are some other benefits that have been touted by both sides of the isle, some have pointed out is that the federal government is paying for it, why not help North Carolinians with federal money, there are some state funds involved, but the bulk of the funding will be covered from federal dollars. Returning to that last group of people switching from an employer plan, Medicaid has broader coverage of items that require no out of pocket costs. Which could mean that people in this group that may have been delaying an elective procedure, could opt to have that done now that they can afford it.
Finally, the budget passed through both chambers of the N.C. legislature on Friday, but Governor Cooper decided not to sign it and let it pass in ten days without his signature. The casinos were dropped from the budget bill and there are discussions this week on when the expansion will get fully implemented.
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