- Expanding Medicaid would be a disaster for North Carolina
- But just stopping expansion is not enough, we must offer alternatives
- There are several other measures NC legislators could take to expand access and reduce costs of healthcare
There is mounting pressure on North Carolina legislators to expand the state’s Medicaid program, as provided for in Obamacare. While conservatives in the legislature have fought it for several years, this has become one of Gov. Roy Cooper’s signature issues, and some legislative Republicans have joined Democrats in support.
Expansion would be disastrous for North Carolina, and we have laid out the arguments why here.
North Carolina must stop Medicaid expansion. But that is only part of the issue. Other reforms to our healthcare system are needed.
Health insurance premiums in North Carolina continue to climb higher and higher, becoming unaffordable for more and more. Too many lack reasonable access to care. Our state needs to take positive action to ensure all North Carolinians have access to affordable healthcare.
Solving this problem requires policies that eliminate government barriers preventing families from having more control and options in their healthcare decisions. Policies must be put in place that create a sustainable, affordable healthcare system without reducing quality or limiting choice.
We can make insurance more affordable by giving consumers more choices. We can eliminate supply restrictions like CON laws and scope of practice restrictions that drive up prices and restrict access, while encouraging cost-saving services like telemedicine and direct primary care. More freedom, and less government control, is the answer.
The Civitas Institute urges legislators to consider the following policies to help reform North Carolina healthcare for the better:
Eliminate Expensive and/or Unnecessary Insurance Coverage Mandates
While the federal government requires states to include a certain number of coverage mandates in their insurance policies, states have discretion over many more. Coverage mandates require all insurance plans to include coverage of certain services or providers, regardless whether or not the consumer wants or needs them. North Carolina currently has at least a dozen state optional mandates, costing an estimated $218 million. Our state imposes the second-most total coverage mandates in the Southeast.
These mandates should be re-evaluated for elimination, and legislators should strongly oppose adding mandates in the future. Consumers should be able to choose which coverages they want included in their plan.
Allow for Association Health Plans
In June of 2018, the Trump administration gave authorization to allow professional associations to offer insurance coverage to their members, with plans avoiding Obamacare’s numerous and expensive mandates.
Association Health Plans (AHPs) allow the self-employed and workers in small businesses not offering coverage to buy in to a group plan offered by the association, even across state lines. Group coverage is typically more affordable than insurance on the individual market, meaning this measure could provide more affordable insurance options to tens, if not hundreds, of thousands of North Carolinians.
For instance, according to news reports, “the Nebraska Farm Bureau and Medica announced they were teaming up to offer a menu of association health plans in 2019 for individual farmers, ranchers and small agriculture-related businesses.” The plans are expected to deliver a premium savings of up to 25 percent.
Allowing for and promoting AHPs in North Carolina could generate significant premium cost savings for health insurance consumers, especially farmers and small business employees.
Allow Consumers to Purchase Health Insurance from the U.S. Territories
A 2014 ruling from DHHS exempted the U.S. Territories from many expensive Obamacare health insurance mandates, enabling the territories to offer less expensive, and more flexible, insurance options.
North Carolina could provide an exemption similar to the one extended for health care sharing ministries to enable North Carolinians to purchase insurance offered by the territories.
Allow Private, Prepaid Agreements Between Doctors and Consumers
Direct primary care (DPC) is a growing medical care delivery mechanism in North Carolina. It involves patients paying a low monthly fee for virtually unlimited access for primary care services from their chosen physician. DPC doctors also frequently dispense prescription medications at wholesale costs.
This arrangement allows providers to avoid the hassle of insurance billing, and generates tremendous savings for patients. While already growing in North Carolina, state legislators could help facilitate the further growth of this practice by passing legislation clarifying that direct care providers shall not be classified as insurance providers, ensuring they can avoid costly compliance measures. Twenty-three states have already passed such legislation.
Don’t Hinder Telemedicine Growth
Telemedicine is the practice of patients connecting with doctors via electronic means – these days largely by video consultation or smart phone apps.
Such services significantly increase patient convenience, expanding access to care – especially enabling those in rural areas experiencing doctor shortages to access a doctor they may otherwise need to drive hours to see. Telemedicine can also encourage more frequent preventative updates and monitoring of patients’ condition, at a low cost.
Telemedicine services are growing rapidly in North Carolina, and state government should avoid any legislation that would impede its growth. One possible impediment would be the implementation of a “parity law” for telemedicine.
A parity law could require insurance providers to bill services rendered via telemedicine at the same rate those services would cost for an in-person visit.
Adding a parity law to telemedicine would subject these services to greater government oversight, increase insurance premiums and shield patients from the actual cost of telemedicine care. All these factors would harm patients and likely slow telemedicine innovation.
Eliminate Certificate of Need Laws
Certificate of Need laws (CON) force medical care providers to get permission from the state government to expand their facilities, introduce new procedures they can perform, and purchase new equipment to provide better service.
This law restricts the amount of medical care options available for patients, limits competition and drives up costs to patients. Placing strict constraints on the supply of any good or service will inevitably drive up its costs.
CON laws are outdated and need to be repealed.
Scope of Practice
North Carolina has an acute health care provider shortage in its rural areas. In a January 2018 meeting of the Committee on Access to Healthcare in Rural North Carolina, experts revealed that in North Carolina, 20 counties do not have a pediatrician; 26 counties do not have an OB-GYN; and 32 are without a psychiatrist. Moreover, 70 of 80 rural counties in NC are currently designated “medical deserts” for their lack of primary care availability.
Current North Carolina law restricts the scope of care that registered nurse practitioners, advanced practice registered nurses, and physician assistants can provide, while also requiring a certain level of supervision by a licensed physician.
With so few licensed physicians choosing to practice in rural areas, laws restricting the ability of highly-trained medical care providers to provide much-needed care are devastating to rural populations.
Freeing them to perform many of the basic evaluation and treatment functions — currently limited to physicians — would drastically improve rural populations’ access to needed care.
Passing legislation empowering registered nurses and other physician assistants would not only expand access to care for rural patients, it would help to lower healthcare prices and create thousands of jobs as well.
When Arizona removed the physician supervision of nurse practitioners, the number of nurse practitioners serving rural areas jumped by 73 percent within five years. North Carolina can do the same for nearly 15,000 advanced practice nurses and physician assistants.
A similar approach could also be taken for dental therapists, to allow them to perform certain duties instead of requiring a licensed dentist.
Additionally, North Carolina could expand scope of practice for pharmacists to allow them to prescribe certain low-risk prescription drugs, enabling patients to avoid the costlier trip to a physician to obtain the prescription.