Just because you do not want to hear a truthful statement, the statement is no less accurate. For example, I do not want to hear that NCSU lost in the first round of the NCAA.  But my desire to not hear that statement does not  render the fact that NCSU lost in the first round of the NCAA  inaccurate.

In recent interviews, Ms.  Steckel has stated some accurate statements about our current state of Medicaid. The statements are not what people want to hear. But the fact that people do not want to hear these truths, does not render Ms. Steckel’s statements inaccurate.

Over the weekend I read an editorial, which caused me to realize that Ms. Steckel’s statements were causing confusion. I wanted to shed some light.  The editorial read, in pertinent part,

“Gov. Pat McCrory’s new state Medicaid director recently gave a troubling rationale for the governor’s refusal to expand Medicaid to 500,000 poor North Carolinians:

“If I gave 700,000 people who don’t have health care coverage a Medicaid card in North Carolina, do you really think they would get healthier?” Carol Steckel asked.

Her statement seemed to imply that she thinks the program she directs is incapable of helping the people who would have been added to the rolls. She said low-income people without Medicaid cards can go to federally qualified health centers, which are focused on primary care and receive billions of dollars to offer sliding-scale fees.”

What Ms. Steckel actually said was accurate.  Let me explain:

Our Medicaid system currently serves approximately 1.5 million North Carolinians. Today, Medicaid recipients have difficulty finding health care providers. One-third of physicians and other providers refuse to accept Medicaid patients. Reasons? Oh the list would be longer than the Great Wall of China, but here are a few reasons:

1.  Low reimbursement rates.  Essential to Medicaid is physician participation. Yet, Medicaid only pays approximately 60% of the total charge to a health care provider providing Medicaid services. For example, if a doctor charges $100/office visit, Medicaid would pay the physician $60. Therefore, most physicians refuse to accept Medicaid. In fact, in rural areas of North Carolina, where the percentage of Medicaid recipients is greatest, there can be a ratio of 200:1 Medicaid recipient to physicians accepting Medicaid. For some rural North Carolinians, the Medicaid card in their hand is worthless; people cannot find physicians accepting Medicaid. This scarcity of Medicaid providers becomes even more of an issue when it comes to dentists. A recent nationwide study indicated that over 60% of dentists refuse to accept Medicaid. The percentage grows if the dentist is a specialist.

2. Harassing audits.  North Carolina is conducting Medicaid audits on health care providers.  The problem is that these audits are being conducted improperly.  The results of the improper audits are health care providers going out of business, feeling harassed, and being forced to discharge clients.

3. Dealing with the government. Enough said.

4. Dealing with the Managed Care Organizations (MCOs). Enough said.

Now, going back to Ms. Steckel’s quote, due to the above 4 reasons and many,  many more reasons, health care providers are quickly ceasing Medicaid work.  Some providers are deciding to no longer accept Medicaid voluntarily. Some providers are being squeezed out of the system by Alliance, Smoky Mountain, Piedmont Behavioral Health or other MCOs.  Some providers are having Medicaid contracts wrongfully terminated by the State. But, regardless the reason, LESS health care providers are accepting Medicaid.

With the amount of health care providers accepting Medicaid going down, the amount of Medicaid recipients is NOT going down.  What does that mean?

It means that MORE Medicaid recipients cannot find quality health care.  MORE Medicaid recipients are being turned away from their providers they had been using for, sometimes, years.  MORE Medicaid recipients are going untreated and ignored because:

THERE ARE NOT ENOUGH HEALTH CARE PROVIDERS WILLING TO ACCEPT MEDICAID.

Ms. Steckel’s quote, “If I gave 700,000 people who don’t have health care coverage a Medicaid card in North Carolina, do you really think they would get healthier?”

Is a sad, but accurate statement.

Does a NC Medicaid card treat Medicaid recipients? No. The health care providers treat people.  Without health care providers, people cannot receive health care.

Think logically, if, currently, our Medicaid system cannot serve the 1.5 million Medicaid recipients  it supposedly serves, what would have happened if NC handed 700,000 MORE people Medicaid cards? The Medicaid cards would have been worth the price of the paper on which it was printed.

Ms. Steckel was right. Medicaid cards do not treat people. Health care providers treat people.

Ms. Steckel’s statement did not imply that today’s Medicaid system could not handle additional Medicaid recipients. I think she explicitly stated that our Medicaid system could not handle 700,000 more recipients. And a Medicaid card would be worthless.