North Carolina's Democratic representatives in Congress are urging federal officials to reject the state's Medicaid overhaul. The state's Republican governor and lawmakers have championed it, and leaders submitted the plan to the federal government in June.
After several years of legislative wrangling over Medicaid cost overruns, Republicans settled on an overhaul last year. It would put hospital systems and insurance companies in charge of managing care and on the hook if they go over budget.
Congressman David Price, a Democrat from the Triangle, calls the changes ill-advised.
"We already have an award-winning Medicaid program in North Carolina, which has been nationally noted," he says. "It's called Community Care of North Carolina and it involves the providers. It's nonprofit."
Basically, Community Care is a network of doctors, nurses and pharmacists who coordinate care for roughly 80 percent of Medicaid patients. Audits have shown it saves the state money and improves patient outcomes.
As insurers and hospital systems take over the coordinating, Community Care leaders say they'll look to partner with them and maintain a significant role.
"I hope they're right," Price says. "But I just don't understand why you would put it in jeopardy and layer this very complicated set of private companies onto a system that's working well."
Cost overruns have not been a problem recently. Still, Republican lawmakers and Governor Pat McCrory say there's room for improvement.
Congresswoman Alma Adams is a Democrat who represents Charlotte.
"I just don't believe the appropriate stakeholders were at the table," she says. "They didn't get the input from the providers who certainly will be caring for our patients. They didn't get input from patients."
That's not true. Lawmakers and Governor McCrory's administration did seek input from doctors and patients. In fact, that's a big reason McCrory's original plan changed to give more responsibility to hospital systems. And state health leaders tweaked the final plan based on public hearings.
Even with that, associations representing hospitals, doctors and patients in North Carolina have concerns.
Adams and Price have an additional reason for their opposition, and it's directly related to another part of the public input. They're among the chorus of people who say North Carolina should expand Medicaid under the Affordable Care Act before making other changes.
Federal officials are expected to take about a year and a half to review the plan.
