JLF Research Archive

Health Care & Human Services

Showing items 1 to 25 of 34

(11.25.13) Redistribution of Health: Severe Side Effects of the Affordable Care Act’s Health Insurance Exchanges

Despite it's promises, the federal health care law will bring premium increases to many due to community rating provisions, increased regulation and mandates, and problems with premium and cost-sharing subsidies.


(10.24.13) Certified: The Need to Repeal CON; Counter to their intent, Certificate of Need laws raise health care costs

Four decades’ worth of data and research into CON laws have shown that they fail to lower health care costs; if anything, they raise them. Despite this, North Carolina hosts one of the most restrictive CON programs in the country. State leaders could best prevent unnecessary increases in health care costs by repealing CON.


(10.22.13) CCNC Flaws: Why Community Care of North Carolina is Failing Patients, Taxpayers, and Policymakers

The debate over NC’s Medicaid program pits defenders of the status-quo Community Care of North Carolina (CCNC) model against reformers touting Governor McCrory’s proposed Partnership for a Healthy North Carolina. This report identifies and explains CCNC’s flaws and shows how the Partnership for a Healthy North Carolina is a far more effective approach to not only improve patient health, but also rein in Medicaid spending and save taxpayer dollars.


(7.10.13) Lessons Learned: How the Partnership for a Healthy North Carolina Avoids Kentucky’s Medicaid Reform Mistakes

Gov McCrory’s Partnership for a Healthy North Carolina is an innovative approach to redesign the state’s Old Medicaid system. This report explains the strategies and provisions included in the Partnership that help to ensure North Carolina’s Medicaid reform does not replicate Kentucky’s failings.


(5.29.13) The Partnership for a Healthy North Carolina: Medicaid Reform that Works for Patients, Providers, and Taxpayers Alike

The Partnership for a Healthy North Carolina infuses the Medicaid program with winning market-based strategies of competition, accountability, transparency and a common-sense funding structure. Although policymakers should explore additional ways to make the Governor’s proposal even stronger, the Partnership for a Healthy North Carolina represents a major step forward in transforming Medicaid into an affordable and successful health care safety net.


(5.20.13) Health Care's New Prescription: The Power To Heal Through Consumer-Driven Medicaid

Medicaid’s ineffective utilization of its unpredictable budget has left the state facing a budget overrun of more than $248 million. Consumer-driven Medicaid reform emphasizes principles of choice, competition, and fiscal responsibility for beneficiaries and providers, giving patients would be able to choose benefits and services that best fit their medical needs from multiple health plans with defined block grants.


(1.05.12) Compensating NC’s Eugenics Victims: Five Ways North Carolina Can Help Right the Wrong

North Carolina forcibly sterilized approximately 7,600 individuals in the 20th Century as part of its eugenics program. Many eugenics victims are still alive in North Carolina. This report offers five ways that North Carolina should compensate the victims before it is too late.


(7.06.11) North Carolina's Forced-Sterilization Program: A Case for Compensating the Living Victims

When North Carolina lawmakers return to budget work next year, they should consider compensation for more than 2,900 living victims of the state's forced sterilization program.


(5.09.11) Reforming North Carolina’s Medicaid Program

Medicaid is a national problem, not just a state problem. All states are faced with the same incentive to grow their Medicaid programs because of the federal match. Unsustainable Medicaid spending is exacerbating the debt crisis at the federal level. It is paramount that state policymakers put pressure on Washington to reform Medicaid and willingly trade the open-ended federal reimbursement of state spending for freedom from federal roadblocks to make common-sense reforms to their programs.


(3.23.11) Repair and Reform Medicaid: Even more essential under ObamaCare

North Carolina has one of the most expensive Medicaid programs in the Southeast, and Obamacare will expand enrollment from 1.3 million people to potentially over 2 million people in 2014. Without Medicaid reform or tighter eligibility, North Carolina will need to cut some services and payments to doctors. Both options will mean worse care for every person on Medicaid. Gov. Bev Perdue and the General Assembly need to push Washington for exemptions from Medicaid restrictions and greater ability to innovate with premium support and encourage patient control of their own care.


(11.12.10) The First 100 Days: Eleven Action Items for the 2011 Legislative Session

This report highlights eleven action items that North Carolina’s new General Assembly should seek to implement in the first 100 days of the 2011 legislative session. These items touch upon a cross section of public policy areas, including education, economic development, property rights, energy and the environment, health care, the budget, and transparency. We at the John Locke Foundation believe that these items represent straightforward actions that would greatly enhance the liberty and prosperity of North Carolina’s citizens.


(9.30.10) The Pill Police: North Carolina law enforcement has access to private health records

There has been significant public attention and concern regarding a proposal by the North Carolina Sheriffs' Association that would allow sheriffs to have access to patients' prescription information for painkillers and controlled substances. The bigger issue is that the state already collects this information and law enforcement, specifically the State Bureau of Investigation, already has access to it. North Carolina should eliminate the database. The incredible intrusion into the lives of citizens greatly outweighs its limited, if any, benefit.


(8.25.10) Deregulating Health Insurance and Health Providers in North Carolina

North Carolina policymakers should eliminate provider licensing, certificate-of-need laws, and mandated health insurance benefits. Short of this, the state can accept alternative forms of credentialing and ensure consumers have the right to purchase optional benefits at additional cost. These regulations limit access to health care providers and health insurance by artificially constraining markets.


(4.22.10) Politics vs. The Health Care Lawsuit: N.C. Attorney General's Decision Is Not Supported by a Proper Legal Analysis

North Carolina Attorney General Roy Cooper decided not to join a lawsuit challenging whether the recently enacted federal health care bill is constitutional. The Attorney General's legal analysis used to justify not taking action avoided the primary legal questions regarding the law's constitutionality.


(10.15.08) Mental Health Reform: Steps Toward Improvement

Mental health reform began in 2001, but has had disappointing results. This paper examines major areas of the mental health system – care management, criminal justice, provider networks, supplemental services, and payment. It offers some evolutionary steps toward improvement.


(2.26.08) Jail Diversion Programs: A step toward better mental health reform

Sixteen percent of all jail and prison inmates have serious mental illness. One in every 10 police encounters involves a mentally ill individual.


(1.21.08) Long-Term Care Financing in North Carolina: Good Intentions, Ambitious Efforts, Unintended Consequences

Long-term care in nursing homes, assisted living facilities, or an individual’s own home, is the largest portion of North Carolina’s Medicaid budget. It is also the fastest growing portion of that budget. As the state’s population ages, it will drive even more demand for these services. Medicaid was not meant to be inheritance insurance for baby boomers, but current policy in North Carolina allows it to be exactly this. Encouraging more people to rely on private payment options, such as reverse mortgages or long-term care insurance, will mean lower state costs for care and better results for individuals. This paper examines the state of long-term care in North Carolina, current abuses of the system, and private payment options.


(7.18.07) Reform the Reform: How mental health reform went wrong and what lies ahead

North Carolina’s 2001 mental health reform was ambitious and well intentioned but flawed.
Many proven ideas did not make the final version of reform and lawmakers immediately raided the mental health trust fund to cover a General Fund fiscal crisis in 2001.


(10.17.06) High-Risk Health Insurance Pools: A step towards an individual insurance market

Health insurance should act like insurance, not a payment plan for regular medical needs. It should also be available for individuals to purchase in a deregulated market. A high-risk pool for health insurance, as in other insurance markets, would keep premiums affordable for the small percentage of those with significant care needs without raising costs for the entire market. The state of North Carolina should finance any high-risk pool entirely through the General Fund and existing taxes, rather than assessments on insurers or other hidden taxes. Money for a high-risk pool can come from Medicaid savings.


(4.05.06) Your Health, Your Choices: Employers and the State Fail to Meet Individual Health Care Needs

Health care is again a top priority for most Americans. Health savings accounts offer promise and are growing in popularity among companies and individuals. Three states will soon begin consumer-directed Medicaid pilot programs. These are more realistic approaches than proposals by the NC Institute of Medicine and others to expand Medicaid or to force employers to provide health insurance. Individuals, not companies or the state, are best equipped to manage their own health care. Health care reform should start from this premise.


(12.15.05) Health Savings Accounts: Consumer-Driven Health Care for North Carolina Public Employees and Teachers

HSAs are a form of medical savings account, similar to the now-familiar IRAs. These accounts are the property of the employee and can accumulate interest and dividends like other savings vehicles. Funds that are not used for health care-related expenses can be used for retirement living and can also be willed to one’s heirs. When combined with a high-deductible health insurance policy, an HSA replaces traditional health insurance coverage – and does so in a way that results in a more consumer-driven approach to health care.


(11.28.05) Certificate-of-Need Laws: It's Time for Repeal

In North Carolina and 34 other states, if you are a health care entrepreneur and you want to do anything from adding a new wing or extra beds to an existing hospital, to opening an office that offers MRI or other services, you need a “Certificate of Need” from the state. If this sounds like the kind of central planning one might find in a socialist economy – it is. In North Carolina, the central planning authority is known as the Health Planning Development Agency, part of the North Carolina Department of Health and Human Services. The role of this agency is to plan economic activity provided by medical-care facilities. This is done down to the most minute detail, circumventing the most basic function of private decision-making in a free enterprise system, i.e., the allocation of resources based on entrepreneurial insight and risk taking.


(11.21.05) Carve the Medicaid Turkey: State Should Eliminate County Share of Medicaid in Five Years

North Carolina is the only state in which counties pay a fixed percentage of Medicaid costs. Counties have no control over how they spend up to 15 percent of their general fund budget and 39 percent of their property tax revenues. Six counties spend more on Medicaid than on education. Program expansions and higher medical costs have pushed Medicaid’s share of county budgets up an average of 18 percent in five years. The General Assembly should act on the recommendation of its own Blue Ribbon Commission on Medicaid Reform to cap and reduce what counties must contribute to Medicaid.


(2.02.05) Get Control of Medicaid: Bringing Costs Into Line Will Help State Budget

States have three direct policy levers to control Medicaid growth: eligibility, services, and payments. North Carolina’s mix of policies has led to some of the highest costs in the South, but the Blue Ribbon Commission on Medicaid Reform would make it even costlier. Tennessee and Mississippi, the two Southern states with higher per capita costs in 2000, have since made significant changes. Georgia and Virginia present different ways to reduce costs, while a 2001 report for the General Assembly presented largely unexploited savings.


(10.20.04) The Tort of Medical Malpractice: Is It Time for Law Reform in North Carolina?

N.C. is currently considering important modifications to its tort law, especially its application to medical malpractice. Proponents say it's the only way to ensure quality medical care remains affordable in N.C. Opponents say fluctuations in interest rates and the "insurance cycle" in general account for premium changes, and that tort reform would imperil the health of North Carolinians by "subsidizing" negligent physicians.


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