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Daily Journal: How to expand insurance coverage without expanding Medicaid

Great ideas from JLF’s Becki Gray on increasing access to care and decreasing costs without expanding Medicaid:

We don’t have to join the government spiral. When we reduce the cost of health care, and as health care costs go down, the cost of health insurance will go down, too, enabling more North Carolinians to afford the health insurance they want and access the health care they need. All without depending on a government one-size-fits-all program. Here’s how we change the trajectory with a package of reforms focused on individualized, innovative ideas driven by free markets and personal choice:

  1. Repeal Certificate-of-Need laws.
  2. Encourage the use of telemedicine.
  3. Expand the scope of practice for providers, allowing them to offer services they’ve been trained to to provide.
  4. Amend supervisory requirements to allow experienced practitioners to provide care where appropriate.
  5. Introduce dental therapy as a way to extend dental care cost effectively.
  6. Encourage direct primary care practices to continue to grow and flourish.
  7. Allow and expand small business health plans to offer more flexibility and customization of health insurance plans.
  8. Adopt a rule, as is being considered by the Trump administration, to require doctors and hospitals to disclose the rates they negotiate with insurance companies.
  9. Establish a foundation to offer grants or low-interest loans for expansion of medical services, assistance with medical training costs, and housing and personal needs for mid-level providers in rural areas. Use a percentage of hospital nonprofit property, income and sales tax relief to fund the foundation. Allow other businesses or philanthropies to contribute to the fund.
  10. Lead the nation and region by establishing a Southeast compact to offer health insurance plans across state lines.
  11. Encourage competition, discourage monopolies and market consolidation in the hospital, insurance and pharmaceutical industries.

Our reform plan must not leave existing Medicaid recipients stranded. We must ensure Medicaid works better and ensure it provides a safety net to those it was always intended to help. About 12,000 current Medicaid recipients are on waiting lists — some five to 10 years long — to receive support services, the ninth-highest in the country. These services are for people struggling with mental illnesses, opioid addiction, or severely disabled children.

Rather than adding 600,000 mostly childless, able-bodied, working-age adults onto a fragile system, let’s allocate the money to reduce the waiting lists and get these people the help they need.

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