Duke/UNC student proposal on Medicaid

“A New Health Reform Framework for North Carolina: Medicaid Reform in Our State” (pdf) is the final product that flowed out of the final paper that graduate students from Duke and UNC turned in for a class that I taught in Fall 2013 entitled “The Future of Medicaid in North Carolina.”

The short version of their recommendation:

  • Expand Medicaid from 0-100% of federal poverty and leverage the infrastructure of Community Care North Carolina;
  • Expand from 100-138% of poverty via “private expansion” meaning using Medicaid expansion funds to pay private insurance premiums in exchanges

The report offers many suggestions regarding health system reform in North Carolina as well, that I won’t detail in this post.

It is safe to say that the students who were attracted to this course were reflexively for the Medicaid expansion, and in many ways “didn’t get” how the state of North Carolina wasn’t undertaking the Medicaid expansion as part of the ACA. Most of them are not from North Carolina, and only came here to study. I tried to push them hard over the course of the semester to take seriously the opposition. They mostly still don’t get the opposition or think it is primarily based on opposition to President Obama, but they wrestled mightily to try and understand the perspective of opponents’, and to fashion what they understand to be a plausible way forward that they believe has given some ground.

I should note that these students did independent cost projections, and considered issues of crowd out and woodwork effects. This report represents thousands of a dollars worth of effort at any sort of market rate, especially that done after the final product turned in for the class.

In the spirit of inquiry, I invite my fellow North Carolinians are opposed to expansion, to come wrestle and reason together with these students in their nuanced pages.

About Don Taylor
Professor of Public Policy at Duke University (with appointments in Business, Nursing, Community and Family Medicine, and the Duke Clinical Research Institute). I am one of the founding faculty of the Margolis Center for Health Policy, and currently serve as Chair of Duke's University Priorities Committee (UPC). My research focuses on improving care for persons who are dying, and I am co-PI of a CMMI award in Community Based Palliative Care. I teach both undergrads and grad students at Duke. On twitter @donaldhtaylorjr

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