Waynesville leaders are calling on state legislators to expand Medicaid, joining a chorus of local governments across the state in hopes of moving the needle in Raleigh.
The Waynesville town board unanimously voted last week for a resolution endorsing Medicaid expansion after a more than hour-long public hearing where key players in the local medical community spoke out on the repercussions of not expanding Medicaid in North Carolina.
Republican lawmakers who have resisted Medicaid expansion claim it would cost too much. But the irony is that failing to expand Medicaid has actually cost the state more, according to those who spoke at the hearing.
People without health insurance don’t get the early, preventative care they need, and instead wait until they are in dire straits before ending up in the emergency room.
“It’s snowballing and they are showing up in the ER on the tail end of their illness,” said Rod Harkleroad, the CEO of Haywood Regional Medical Center, who was one of those who spoke at the public hearing.
By then, they need far more expensive treatment, and society ends up picking up the tab for anyway, Harkleroad said. The unpaid medical bills are ultimately passed down in the form of higher insurance premiums and medical costs to everyone else.
Haywood Regional Medical Center has to write off $24 million a year in charity care for patients who can’t pay their medical bills. Of the 50,000 patients who come through the ER at Haywood Regional, around one-third don’t have insurance. Those stats demonstrate the pattern of the uninsured waiting until their health is in crisis before getting care.
“The best way to save health care dollars is to keep people healthy. So we want them to go to the doctor before they are in crisis mode,” said N.C. Rep. Joe Sam Queen, D-Waynesville. “It is proven this saves money.”
Hospitals sweeten the pot
Harkleroad has visited with numerous legislators over the past two years to explain how not expanding Medicaid is hurting smaller community hospitals.
The federal government picks up 90 percent of the cost for states to expand Medicaid. The 10 percent North Carolina would have to pick up is cited as a deal breaker by the Republican lawmakers blocking it.
Underscoring how critical Medicaid expansion is to hospitals, hospitals and managed care organizations have agreed to pay that 10 percent themselves — a compromise that’s at the crux of a new Medicaid expansion bill before the General Assembly.
Since the majority of Medicaid expansion costs are paid by the federal government, North Carolina taxpayers are footing the bill for Medicaid expansion in other states but not getting their piece of the pie.
“The end result is when we don’t pass Medicaid, they are giving our money we make in this state and giving it to another state to use,” Harkleroad said. “We need to line ourselves back up with other states and start moving forward.”
Adding insult to injury, hospitals in states that haven’t expanded Medicaid have been penalized by lower reimbursement rates. The passage of Obamacare had been predicated on states expanding Medicaid. In exchange for picking up the tab for Medicaid expansion, the federal government lowered the reimbursements hospitals get for Medicaid patients.
“Obamacare said ‘Look, we’ll make you a deal. We are going to cut your reimbursements but we are going to offset it by more patients coming through your door,’” Harkleroad said. “For the states that didn’t do that, the hospitals have taken the cut on the reimbursement but never increased the number of patients they would have gotten from Medicaid expansion.”
Hospital finances aside, Harklerod said he also looks at the issue from the lens of a former nurse, citing studies that document lower mortality rates in states that have expanded Medicaid compare to those that haven’t.
“There’s patients who are behind this and we are getting caught up in politics instead of taking care of people,” Harkleroad said.
North Carolina is one of only 14 states that haven’t expanded Medicaid. It has primarily affected the working poor who fall in a coverage gap as a result — they make too much to qualify for Medicaid and too little to qualify for the health insurance marketplace exchange.
In Haywood County alone, there are 3,400 people without health insurance who would be covered by Medicaid expansion, Queen said. If those people were getting healthcare, it would create jobs in the healthcare profession. Queen said 400 jobs would be created in Haywood County in the healthcare industry if the state expanded Medicaid, citing studies that have quantified healthcare jobs tied to Medicaid expansion
“Everybody wins,” Queen said. “My mantra is stop the waste. It is a situation that has to be rectified.”
Republican lawmakers seem more concerned with making a political statement by thumbing their nose at Obamacare, even if it means sacrificing the well-being of their own citizens, Queen said.
“It’s time the citizens understand what’s at stake and make their case to elected officials to do the will of the people,” Queen said.
The idea for a town resolution endorsing Medicaid expansion came from Waynesville Alderman Jon Feicther.
Feichter saw the issue of Medicaid expansion as “inextricably linked” to another issue the town is currently grappling with: how to fix a growing homeless population.
“The lack of health insurance by so many in our state contributes significantly to homelessness in our community,” Feichter said.
Dr. Don Bukner, the CEO of Meridian Behavioral Health, has seen how those living paycheck to paycheck without health insurance can be forced into homelessness either by spiraling medical costs or because they can’t afford mental health and substance abuse treatment.
“They end up burning through their resources,” Buckner said.
Feichter coordinated testimony from a handful of guest speakers from the healthcare and mental health fields to share their insight on Medicaid expansion during the public hearing. Not a single speaker came before the town board to voice opposition to Medicaid expansion.