Based on comments made in yesterday’s joint news conference with Gov. McCrory and State Auditor Beth Wood, North Carolina will, most likely, be reforming Medicaid, not expanding. (Author’s note: McCrory never said NC will not expand Medicaid. He said that, right now, it is in NC’s best interest to reform Medicaid.  There is a chance that I am wrong and NC will accept the chance to expand under Obamacare.)

I foresee lots of civil upheaval from many North Carolina residents. However, before our emotions overcome us, our minds shut to the possibility that the decision is a good one for NC, and we scoff at the government’s lack of humane and moral character…..

Let’s look at the facts:

1. The North Carolina Medicaid system is broken.

2. Todays NC Medicaid recipients receive sub par health care services.

3. NC does not have enough physicians or health care providers accepting Medicaid to cover the number of Medicaid recipients.

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.

What would happen if North Carolina were to accept federal dollars to expand Medicaid? Approximately 720,000 more North Carolinians will be covered by Medicaid. But the laws do not require additional doctors to accept Medicaid. 720,000 more North Carolinians covered by Medicaid means: many people holding Medicaid cards will have no doctor/dentist willing to treat them.

So how does “too many Medicaid recipients and not enough physicians accepting Medicaid” affect the real world? Let me tell you a story:

It is 2007 in Maryland. A 12 year old boy named Deamonte Driver complained to his mom that he had a toothache. Deamonte’s family depended on Medicaid for health insurance. Deamonte was eligible; he held a Medicaid card. Deamonte’s mom called and called and searched and searched for a dentist willing to accept Medicaid. Unsuccessfully. Sadly, unbeknownst to Deamonte’s mom, Deamonte suffered a tooth abscess.  Unable to find a Medicaid-accepting dentist, weeks later, Deamonte was admitted into the ER.  Deamonte’s bacteria from the tooth abscess, the tooth which could have been extracted for approximately $80, spread into Deamonte’s brain. After 2 operations and a 6 week hospital stay (for approximately $250,000), Deamonte died. All because Deamonte’s mom could not find a dentist willing to accept Medicaid.

The disparity between the quality of health service to those people with private insurance versus those people with Medicaid reminds me of a sad part of U.S. history…when U.S. implemented “separate but equal” for blacks during the Civil Rights movement. In the pivotal case of Plessy v. Ferguson in 1896, the U.S. Supreme Court ruled that racially separate facilities, if equal, did not violate the Constitution.  Much later, Chief Justice Earl Warren, following the decision of Brown v. Board of Education of Topeka, stated that “separate but equal is inherently unequal.”  The general implications of the Warren Court opinion, however, are applicable to a great variety of separations, such as the separation of quality medical care for those people with private insurance and the sub-par health care for those people who depend on Medicaid for insurance. Separate is not equal. Giving more people a Medicaid card does not provide health service.

People with Medicaid deserve the same quality health care that people with private health insurance receive. But expanding Medicaid will do the exact opposite. More people will depend on Medicaid, and more people will receive sub-par health services…or worse, no health care at all.

So I, for one, applaud Gov. McCrory for tackling the immense beast of reforming NC Medicaid. Good for you, Governor!

NC Medicaid recipients deserve quality health care. Let’s take our broken Medicaid system and fix it!