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Preventive Services. While I do not agree with all aspects of the waiver, I have tried to give it the benefit of the doubt and to identify common goals for health reform and ways in which the envisioned plan could improve the value we receive for what we pay for care [ 11 ]. Increasing the value we get for our health care dollars is perhaps the key health policy goal writ large for our nation. In my book, Balancing the Budget is a Progressive Priority , I argue that addressing health care costs is the only way to develop a sustainable federal budget in the long run, and that universal coverage is a necessary but not sufficient condition for doing so [ 12 , 13 ].
Simply put, we will not undertake the hardest steps on cost control without having a more straightforward means of guaranteeing at least basic access to care for all persons. There are a number of different innovative policy reform ideas that North Carolina may pursue, but successful implementation of any of them is going to be complicated if we do not insure as many people as possible, as quickly as possible, because caring for the uninsured population imposes costs on the state's health system that are higher than necessary, opaque, and borne unevenly throughout the health system and tax base.
The uncertainty and unpredictability caused by an unnecessarily large uninsured population makes it difficult for stakeholders such as providers and payers to make confident decisions about the way forward and creates obstacles to successful reform. There is a political component to Medicaid expansion that cannot be ignored. The legitimate differences of opinion about the best way forward for health policy in North Carolina and the political opposition to President Obama have caused our state to largely sit out health reform so far, and we are now bearing the consequences of inaction [ 14 ].
Our state must now fully engage health reform.
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Expanding Medicaid would stabilize the health environment in North Carolina by infusing the state with extra federal dollars for health care, thus setting the stage for advancing additional reforms to reduce total costs and increase the quality of health care for all North Carolinians. We will only accomplish ambitious transformation of our health system if Republicans, Democrats, and Independents own responsibility for reform.
For Democrats, expanding insurance coverage is the paramount health policy goal. The McCrory administration outlined their goals in a June Medicaid waiver application that they said would increase budgetary predictability and move away from fee-for-service payment for the existing Medicaid program, which would be a key step toward increasing value for Medicaid expenditures.
There are aspects of the waiver that will likely find favor with the new governor, who is responsible for running Medicaid, and other aspects that will not, but there is bipartisan consensus that delivery system changes are needed. As the reality of removing Medicaid expansion from states comes into focus, I suspect that some type of Medicaid-type expansion opportunity for states will remain. There is almost certainly no more financially advantageous means of expanding coverage that will be available to North Carolina.
The details are crucial, but infusion of more federal resources into our state could help to jump-start the broader insurance and delivery system reform efforts that our state needs. Independents want to see both sides work together practically to solve problems.
A deal between the 2 sides should be readily available, and hammering out a Medicaid reform plan that expands coverage while restructuring the program to address costs and improve quality of care would set the state on a path to a higher-value health system. If we advance bold new reform ideas and commit to evaluating and sharing what works and what does not, we could not only improve our own health care system but become a model for other states, especially in the South. That outcome would make all Tar Heels proud.
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Andrew Olson and Matthew Harker provided valuable help and support in reviewing this paper, but any errors are the responsibility of D. Potential conflicts of interest. No one from that organization has reviewed this paper, and D. All rights reserved. Donald H. Previous Section Next Section. View this table: In this window In a new window. TABLE 1. Previous Section. The Henry J. Kaiser Family Foundation website. Published February Accessed September 15, Google Scholar.
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Changes in Eligibility, Enrollment, and the Uninsured. Accessed September 14, Accessed December 8, Washington, DC : Henry J. Kaiser Family Foundation ; Published September 6 , February 10 , Taylor DH Jr. Medicaid Waiver.
Published July 24 , Balancing the Budget is a Progressive Priority. New York, NY : Springer ;
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