May 6, 2013
Some political decisions affect a small group; others impact us all. On February 5, North Carolina senators passed Senate Bill 4; the equivalent bill in the House — 16 — was passed February 26. Both mandate that the state will opt out of Medicaid expansion. This is the case, despite the fact that the Affordable Care Act pays for Medicaid expansion for the next three years, after which the federal government will never pay less than 90 percent of the state’s costs.
Regional Economic Models Inc., an economic modeling firm, highlighted benefits of Medicaid expansion for our state’s struggling economy. The expansion could result in 23,000 more jobs, $1.4 billion higher gross domestic product (GDP) and a rise in annual disposable personal income to $1 billion.
Without Medicaid expansion, North Carolinians will bear the burden of paying for the sick seeking health care in emergency rooms and safety-net clinics. My organization, Triad Adult and Pediatric Medicine, is among the groups that will bear that burden.
We are medical home to 54,000 adults and children, all with annual incomes at or below 200 percent of the federal poverty level. Seventy percent of those adults and five percent of the children are uninsured. In 2012, we provided 90,000 patient visits, of which 30,814 were for the uninsured.
Our cost per visit is $176, as compared to a non-urgent emergency room visit costing an average $800 in our area. If we were not here, the uninsured would seek care at emergency rooms. This could cost the community $24,651,200 — a total greater than Triad Adult and Pediatric Medicine’s entire annual budget of $16.2 million. It is estimated that $500 of employer-sponsored health insurance premiums are attributable to cost-shifting, i.e., hospitals moving costs of providing care to the uninsured onto the insured.
It is important to expand Medicaid, while at the same time holding accountable providers, insurers and recipients of care. Only then will we achieve both clinical and financial outcomes that will sustain our health-care system.
Brian Ellerby, MSPH, a 1988 health policy and management alumnus (then health policy and administration), is chief executive officer of Triad Adult and Pediatric Medicine in Greensboro, N.C., an organization with a mission to provide family health care that is comprehensive, holistic and delivered with a spirit of compassion and respect.
Carolina Public Health is a publication of the University of North Carolina at Chapel Hill Gillings School of Global Public Health. To view previous issues, please visit sph.unc.edu/cph.