As a pediatrician who has spent most of the last 42 years working with state and federal government leaders to improve children’s access to comprehensive health services, I find our General Assembly’s stance against Medicaid expansion totally unacceptable.
Ninety-six percent of children in our state have health insurance (Medicaid, Children’s Health Insurance Program or private insurance) meaning that primary care physicians can afford to welcome ALL children into their practices; the 4 percent “self-pay” usually qualify for our “sliding scale” for payment, so nearly ALL children in our state have access to primary care in a medical home. Physicians have worked with our state government leaders to improve Medicaid and add CHIP, so that most physicians welcome Medicaid and CHIP patients into their practices, alongside children who have private insurance. In our seven-county catchment area, our practice can coordinate care in four offices and six school-based health centers so that thousands of children’s parents can obtain health services for their children, including the ability to talk with a physician who can see their children’s electronic health records 24-7.
On the adult side of medicine, large numbers of patients cannot afford insurance and do not qualify for Medicaid or Medicare. Therefore, physicians who care for adult patients cannot develop a system of care like the one at Goldsboro Pediatrics. Physicians cannot afford to have an “open door” policy for accepting adult patients into their practices. Therefore, many adults go without health services until they are sick enough to need a hospital emergency department or hospital inpatient team. We have lost the notion of patient access to preventive health services and are paying for a very expensive sick-care system for adults.
Obamacare was an imperfect attempt to help patients afford health insurance. The Medicaid expansion clause of Obamacare would give patients access to Medicaid if their annual incomes are at or below 138 percent of federal poverty guidelines ($17,000). When the courts made Medicaid expansion optional, and our state chose not to expand Medicaid, adults with incomes less than 100 percent of federal poverty guidelines ($12,000) could not even purchase health insurance on the Obamacare exchanges.
When our state applied for a 1115 Waiver to get permission from the federal government to privatize our Medicaid program, Carolina Cares was included, despite the General Assembly failing to approve the Carolina Cares proposal that would have given thousands more adults access to Medicaid and have some “skin in the game.” The federal government approved the waiver but could not approve Carolina Cares without General Assembly approval.
As we continue to address access to comprehensive health services for ALL our people, I think we need to start by trying to create a health care system for adults that is at least as good as the one we have for children! We have a long way to go! The first step would be a “CHIP for Adults,” or whatever you want to call our state’s option to accept federal Medicaid dollars to give more low-income adults access to the health services we all need.