By Chris Fitzsimon
Tuesday’s budget and tax briefing for state lawmakers was billed as a look at the “major drivers†in the growth of the state budget, with most of the time spent on trends in education and Medicaid. Lawmakers will hear more detailed reports on both issues in the coming days, but Tuesday’s Medicaid overview and the questions and comments it prompted are reminders of how many legislators view the program — as a burden from which we need relief, a major drain on the state budget.
Medicaid costs have grown an average of 9.3 percent a year in the last nine years and the program now covers 18 percent of the people in North Carolina. The budget passed last session included $2.9 billion for Medicaid, the single biggest state expense in health and human services.
Evan Rodewald of the Legislature’s Fiscal Research Division said three factors contribute to Medicaid’s growth: inflationary increases, new technologies and higher enrollment, though the costs of Medicaid generally grow less than the costs of health care in the private sector. The questions from lawmakers were not about technology or the escalating costs of medication. Instead they wanted to know if the state’s eligibility standards were in line with other states and how generous were the services that Medicaid offers.
That’s a version of a talking point from the market fundamentalist crowd – that North Carolina’s Medicaid program includes too many services not mandated by the federal government. Raleigh’s leading right-wing think tank has called many times for North Carolina to drop all optional services, which include ambulance service, orthotics and medication.
One version of budget cuts this year included ending podiatry coverage, even though some seniors with diabetes are at risk of losing their feet and never walking again.
Medicaid isn’t just a budget driver, it’s a life saver.
Just over 1.6 million people in North Carolina qualified for Medicaid in 2007 based on income and health status. The majority of recipients are very poor children or seniors or people with disabilities. Two-thirds of people covered by Medicaid are female and the majority of them are white.
Many uninsured adults do not qualify for Medicaid regardless of income. It is a program targeted to specific groups of people. It is also a success story, providing a health care safety net for the most vulnerable people in the state with far lower administrative costs than private insurance.
Many lawmakers and think tanks proposing cuts in Medicaid don’t want to talk specifics, because the details make their suggestions absurd. Sixty-four percent of Medicaid spending goes to help seniors and people with disabilities. Another 14 percent covers poor kids. Then there are pregnant women and AFDC recipients under 21.
People advocating significant reductions in Medicaid should be forced to explain which group they want to deny services to or who shouldn’t have access to an ambulance when they have a heart attack or an artificial limb when they lose an arm or leg.
Rodewald told lawmakers Tuesday that Medicaid costs usually increase during economic downturns. More people are eligible after losing jobs and the health care that comes with it. That makes talk of Medicaid cuts this session even more irrational.
The stimulus package that finally emerges from Congress is all but certain to provide more Medicaid funding for North Carolina. That will help. So would a different view of Medicaid.
It is a public program that works and helps thousands of people every day. That’s something to be proud of, not something to complain about. And it’s also something to protect, especially this year.
Chris Fitzsimon is the director of NC Policy Watch.