LEIGHTON KU: 'Medicaid expansion can and does improve access to care'

Wednesday, Oct. 16, 2019 -- Medicaid expansion can and does improve access to care. It is not a cure-all. Doctors, nurses, state officials and others will continue to need to do hard work on health problems to improve care for people. Medicaid expansion can provide billions of new dollars to North Carolina to support health care.

Posted 9:00 a.m. Oct 16, 2019 — Updated 9:00 a.m. Oct 16, 2019

EDITOR’S NOTE: Leighton Ku is lead author of the study, “The Economic and Employment Benefits of Expanding Medicaid in North Carolina.“ The initial study came out in 2014 and was updated in June 2019. He was in North Carolina earlier this month to discuss his report on behalf of Medicaid expansion backers. Among the findings Ku highlights from the report: It would extend health coverage to 640,000 North Carolinians – mostly working families – who now lack access to health care; About $8 billion in federal taxes collected in North Carolina are being used in other states to finance Medicaid expansion. Additionally, it would generate 37,000 new jobs and inject $12 billion federal dollars into the state’s economy over the next three years. Expanding Medicaid would be “a good thing for North Carolina” -- good for the health of the people and economy, he said.

Senate leader Phil Berger, R-Rockingham, has led opposition to Medicaid expansion and blocked any consideration of it. In a recent op-ed column, Republican state Sen. Jim Perry of Lenoir County cited a 2011 study (prior to the Medicaid expansion program now being discussed) Ku led that contended states could face “surging demand from the newly insured population without having sufficient primary care resources available.” The result Perry says in his column is “adding another 500,000 or more people to the Medicaid rolls would only make this problem worse and put traditional Medicaid program enrollees at risk.”

Ku, the director of the Center for Health Policy Research and professor of health policy and management in the Milken School of Public Health at George Washington University, provided the following reply to Perry’s op-ed.

Sen. Jim Perry recently wrote an op-ed expressing concerns that expanding Medicaid could create pressures on the availability of primary care physicians, which has declined in North Carolina. He even cited a 2011 article that I wrote, before the Medicaid expansions began, about the risk of this. I appreciate Sen. Perry raising this issue (and am a little amazed that he tracked down an old paper of mine!)

Since Medicaid expansions began in 37 other states in the nation, there have been a great number of studies examining what happened. They invariably show that the insurance expansions improved access to care. More than half a million uninsured North Carolinians who could gain insurance if the state expanded Medicaid would be able to afford medical care. This occurred in both urban and rural areas.

Part of the answer is that safety net providers, like community health centers, stepped up to the bat to expand capacity, knowing that Medicaid expansions would help make this possible both by increasing Medicaid revenue and reducing uncompensated care pressures. Moreover, many medical practices have learned how to become more efficient and effective, by increasing collaborations with other health professionals, including nurse practitioners, physician assistants, nurses and care coordinators. The additional insurance revenue helps clinics pay for these additional resources. In many states, the expansion of Medicaid managed care systems has helped increase the connection between patients and their primary care doctors.

This past weekend, I visited old friends in Maine which recently expanded its Medicaid program. One of my friends is a family physician in rural Maine, which also has a limited supply of doctors. He explained how Medicaid expansions have helped in his area, as he has worked to respond to problems like opioid addiction in his state, which is facilitated since more have insurance.

Medicaid expansion can and does improve access to care. But I agree that it is not a cure-all. Doctors, nurses, state officials and others will continue to need to do hard work on health problems to improve care for people. Medicaid expansion can provide billions of new dollars to North Carolina to support health care.

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