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Medicaid Expansion, Polarization, and Diving Head-First Into the Unknown

I have always believed in the concept to think first, act second. I rarely react; I try to act. In politics, generally, this mantra is not followed. If a public poll states that the public is in favor of X, then the leaders need to consider X. If it is an election year, then the politicians will do X.

I’m reminded of an awful book I read a couple of years ago. I can’t remember the name of it, but it began with a young teen-age couple at a lake. The boyfriend dives off of a dock into the lake and dies because his head hit a rock underneath the water. (I do not suggest reading the book). But I remember thinking… “How tragic,” then… “Why in the world would this guy dive head-first into a lake without knowing the depth or pitfalls? This was a preventable death.”

This is a perfect example of why we should think first, act second.

However, in politics, the polarization of the two parties, Republican and Democrat, sometimes causes politicians to RE-act according to the party lines. Nowhere is this polarization more prevalent than the concept of Medicaid expansion. See my blog: “To Expand, Or Not To Expand, A Nationwide Draw?” It seems that if a state has a Republican governor, without question, that state will refuse to expand (I know there are few exceptions, but there are few). If a state elected a Democratic governor, then the state has elected to expand Medicaid.

Are these issues so black and white? Or have we become so politically polarized that true intellect and research no longer matters? Doesn’t that actual state of the state matter in deciding to expand?

For example, according to a 50-state survey by USA Today, North Dakota is the best run state. North Dakota has zero budget deficit, and an unemployment rate of 3.1%, the lowest of all 50 states. North Dakota has opted to expand Medicaid.

On the other hand, according to the same study, North Carolina has an unemployment rate of 9.5%, which is the 4th highest in the nation. What does high unemployment mean? A large number of Medicaid recipients.

North Dakota has approximately 82,762 Medicaid recipients, according to the Kaiser Foundation for FYE 2010. Conversely, North Carolina, for the same year, had 1,813,298 Medicaid recipients.

So my question is: Can, or should, a state with 1.8 million Medicaid recipients adopt the same Medicaid eligibility rules as a state with 82,000 Medicaid recipients?

And how can we know the consequences of expansion prior to deciding to expand? Because, after all, shouldn’t we think first, act second? Who wants to dive into an unknown lake?

But issues that apparently no one had contemplated are cropping up…

States across America are seeing unexpected Medicaid costs increase. According to the Associated Press, prior to Medicaid expansion there were millions of Americans who were eligible for Medicaid but who, for whatever reason, had never signed up. Now that there has been so much publicity about health care, those former un-insured but Medicaid-eligible people are signing up in droves.

In California, State officials say about 300,000 more already-eligible Californians are expected to enroll than was estimated last fall.  See article.

Rhode Island has enrolled 5000-6000 more than its officials expected. In Washington State, people who were previously eligible represent about one-third of new Medicaid enrollments, roughly 165,000 out of a total of nearly 483,000.

While the Feds are picking up the costs for Medicaid recipients now eligible because of the expansion (at least for a few years), state budgets have to cover these new Medicaid recipients signing up who had been eligible in the past.

For states blue or red, the burden of these unanticipated increased costs will be on the shoulders of the states (with federal contribution).

Going back to the extremely polarized view of Medicaid expansion (Democrats expanding and Republicans not expanding)…maybe it’s not all black and white. Maybe we should shed our elephant or donkey skins and actually research our own states. How many Medicaid recipients do we have? What does our budget cover now?

Maybe we should research the consequences before diving in the lake.

Aldona Wos: New Head of DHHS

December 13, 2012, Governor-elect Pat McCrory appointed Aldona Wos as the new head of the Department of Health and Human Services (DHHS).

But who is she? Will she proceed differently than former head of DHHS Albert Delia?

Wos (pronounced Vosh) is a native of Poland.  She is a retired physician and, in 1997,   moved to Greensboro when her husband, Louis DeJoy,  set up a business there.  Wos” husband, Louis DeJoy, is Chief Executive Officer of New Breed Logistics, Inc., a privately held third-party logistics company founded in 1968 and headquartered in High Point, North Carolina.

Once Wos moved to NC, she became an avid Republican Party fund-raiser. She was appointed North Carolina State Chair of Women for Senator Elizabeth Dole.  For the 2004 Bush/Cheney presidential campaign, Wos served as the Carolina Finance Co-Chair.  President George W. Bush appointed her to two terms on the U.S. Holocaust Memorial Council, which was apropos, since Wos’ father was a Holocaust survivor.

From 2004-2006, Wos served as the Ambassador to Estonia.

According to, in 2008, Wos donated $73,120 to the Republican party.

Does the fact that Wos contributed to the Republican Party for years and was appointed by a Republican governor mean that Wos is not qualified for the job?

I think not. Obviously, Wos is a retired-phyician.  She has the health care knowledge from the perspective of a physician. This could be a great thing! Hopefully she will have first-hand knowledge of the need for physicians to receive higher Medicaid reimbursements

Also, Wos is no Newby to politics. Her past political contributions and public service shows a great love for this country, which is not her native country.

I could not find much about Wos between 2006 and 2012 (her appointment as head of DHHS). There has been a lot of criticism of Wos due to her contributions to political campaigns.  But, I say, let’s see what she does. She is obviously educated in health care and savvy in politics…which makes her qualified without question as head of DHHS.

Look at former head of DHHS Albert Delia.  He was not a physician. Before he served at head of DHHS he was Gov. Purdue’s chief policy advisor and Senior Advisor. I was unable to find any positions Delia held prior to head of DHHS that would have made him uniquely qualified to head DHHS at all.  (Which is better? Being appointed because you were involved in the governor’s politics as a career? Or being appointed because you contributed to campaigns, but held your own medical degree?)

I’m not saying Wos is qualified merely because she is a physician.  I’m just saying let’s give her a chance because she does seem qualified, regardless of her campaign contributions. Plus, having someone who worked at a physician may have its benefits.  We will see…