Last week North Carolina Democrats held a hearing at the legislature on Medicaid Expansion which included expert commentary from Dr. Leighton Ku, a professor and director of the Center for Health Policy Research at The George Washington University.
While Dr. Ku discussed his perception of the benefits to North Carolina of expanding Medicaid, the hearing did not delve deeper into the risks of Medicaid expansion that many Republicans have continued to bring up, including one that Ku himself expressed in an article published in the New England Journal of Medicine: that adding hundreds of thousands of additional people to the Medicaid rolls will only further exacerbate the primary care shortage that already exists in the state.
In his article, written in 2011 before Medicaid expansion started, Dr. Ku said that once expansion starts, states could, “...face surging demand from the newly insured without having sufficient primary care resources available. These gaps could affect access to care not only for newly eligible beneficiaries but also for others who depend on a state’s existing supply of clinicians.”
Republicans in North Carolina share these same concerns that Dr. Ku expressed in his 2011 article. In North Carolina almost 2 million people already live in a primary care shortage area in North Carolina, and access to health care is a daily struggle for many North Carolinians, especially in rural areas. Adding another 500,000 or more people to the Medicaid rolls would only make this problem worse and put traditional Medicaid program enrollees at risk, as low-income parents, children, pregnant women, the elderly, the blind, and the disabled would now have to compete for access to health care with able-bodied, childless adults.
The shortage of primary care providers would likely be even worse than Dr. Ku predicted in 2011, as those predictions were based off projections on how many people may enroll in Medicaid under expansion. In practice, numerous expansion states have seen enrollment numbers that are up to 50 percent higher than the Congressional Budget Office expected before the expansion took effect in 2014.
Dr. Ku also predicted in his 2011 article that the Affordable Care Act (ACA) would help meet the heightened demand for health care services under expansion by increasing the Medicaid fee for primary care, saying it, “...should make Medicaid more attractive to primary care practitioners.” The reality is that, according to Sheps Health Workforce NC, the rate of primary care providers per 10,000 residents has dropped from 7.78 in 2011 to 7.01 in 2018. At the same time, the number of primary care physicians in North Carolina has dropped from 7,527 in 2011 to 7,287 in 2018 while the population of the state has increased from roughly 9.5 million in 2010 to more than 10.3 million in 2018.
A recent survey examining the time needed to schedule a new patient physician appointment in 15 metropolitan areas showed that since Medicaid expansion started in 2014, average new patient physician appointment wait times have increased by 30 percent. The fact of the matter is, Medicaid expansion just puts further strain a system that is already strained. As Dr. Ku himself said, “If the new demand exceeds the supply of care, the result could be increased waiting times and access barriers.”
Everyone can agree that something needs to be done to address the issue of health care for the working poor. If we believe in the ingenuity of the American people, how can we possibly accept that we only have a binary response for such a complex issue? It is disingenuous to only focus on the positive aspects of expansion while ignoring the very real risks. It is also impossible to have a productive conversation with someone when you open by impugning their motives, and telling them their core beliefs are wrong. This behavior is demonstrative of the breakdown of political discourse in our state and country. Democrats and Republicans should work together to find solutions that solve problems for North Carolinians. One size does not fit all.When we focus our efforts on political theatrics and national political agendas, North Carolinians lose. I welcome a special session with a singular focus on health care.