Health Care Reform
The Patient Protection and Affordable Care Act (PPACA), also known as Obamacare, was passed in 2010 in a hurried process that allowed for little understanding of what was in the 2,700-page document. As the nation waits to see what the future of health care may look like, it is imperative that the states continue to take action at the state level to improve health outcomes and lower costs.
Of particular concern to the future of North Carolina has been the PPACA expansion of the jointly funded Medicaid program. Under PPACA, the state would see the largest expansion of this entitlement program in history. Instead of a federally controlled system, Medicaid, like other health programs, needs to be more focused on the particular cultures, ideas, and needs at the state level. The recent ruling upholding Obamacare has held that the federal government cannot enforce this provision on the states by withholding federal funding.
Some of the most effective and innovative health care reforms can be made at the state level. Some reforms would rein in the ever-growing costs of health care while others would create infrastructure to implement long-lasting reform for the future. The state does not have time to wait on improving health care and must do so with or without federal action.
- 2011 estimates indicate PPACA will add 15 million people to Medicaid rosters across the country, and 500,000 in North Carolina.
- Candidate Obama promised that health care premiums would go down by $2,500 by the end of the first year.
- President Obama now acknowledges that insurance premiums will rise 10-13 percent on average by 2016, and 17 percent for young healthy individuals.
- PriceWaterhouseCoopers has projected that health care spending for 2013 will increase by 7.5 percent, more than three times the projected rates for inflation and economic growth.
- Allow free enterprise to thrive. State restrictions, especially those mandated by the federal government, on health insurance and care provisions mean patients will see alternatives leave the marketplace, potentially driving up costs. Some changes the state should make are:
- Allow individuals and businesses to purchase insurance from other states,
- Reduce mandated benefits for insurance companies,
- Ease restrictive licensing burdens on medical professionals, and
- Repeal Certificate of Need.
- Opt out of participating in PPACA's expansion of Medicaid.
- Use block grants, managed care, and financial incentives to help control Medicaid costs. North Carolina's Medicaid program is expensive and poorly structured. Providers and patients have few incentives to deliver care efficiently, and there is insufficient attention paid to detecting and ending Medicaid fraud.
- Wait to implement Insurance Exchanges. Given the unreasonable time frame for setting up state-level exchanges and how many unknowns that still are associated with PPACA, the state should not rush forward to implement an expensive program it may not need.
Analyst: Nicole Fisher
Adjunct Health Care Policy Analyst