JLF Research Archive
Showing items 1 to 25 of 29
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Sixteen percent of all jail and prison inmates have serious mental illness. One in every 10 police encounters involves a mentally ill individual.
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.
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.
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.
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.
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.
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.
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.
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.
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.
More than a decade after the passage of the Americans with Disabilities Act (ADA) in 1990, disability policy in the United States remains fraught with uncertainty, dashed hopes, and contradictions. While most persons living with disabilities today have an unprecedented quality of life — largely the product of medical and technological advancements that would have seemed more the realm of science fiction than science fact a generation or two ago — they are also experiencing some surprisingly negative trends.
North Carolina has now joined many other states and the federal government in debating solutions to the problem of rising costs in medical malpractice insurance. Evidence suggests that flaws in our tort laws and procedures are a major part of the problem. Proposed state legislation to cap “pain and suffering” awards and implement other reforms represents a good starting point, but state lawmakers should also look at a “loser pays” rule and judicial oversight of expert testimony to reduce the impact of junk science and quack medicine on jury deliberations.
The American Lung Association's annual "State of the Air" reports are treated as scientific and informative by the state news media. They are neither. They use outdated information that reflect changing weather patterns rather than real pollution and are biased against jurisdictions like North Carolina with high numbers of ozone monitors. As a result, the reports supply propaganda for lobbyists for heavier regulation but do a great disservice to science and the general public.
A new study in the Journal of the American Medical Association alleges a significant increase in lung cancer risk for those exposed to high-levels of particulate matter, commonly called soot. In North Carolina, the news media and others have cited the study to boost support for the proposed Clean Smokestacks bill. But according to expert analysis, the study is so flawed that it should have been rejected by the journal. Moreover, it does not establish a case for new regulation.
To date, debate over the proposed Clean Smokestacks bill has focused primarily on the purported air-quality benefits, which would be negligible. Little attention has been paid to the cost, which could be substantial given North Carolina's already high electricity and tax rates compared to its neighbors'. This study estimates the impact on such institutions as school districts and manufacturers. The higher prices and lost jobs must be weighed against any potential benefits.