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.

Future of Medicaid Class: Charge & Questions

I am very excited to be teaching a new Masters of Public Policy course this Fall on The Future of Medicaid in North Carolina. The 14 students all have background in health policy, including prior job, coursework and recently completed internships.

The charge to this class is going to begin with the charge that the recently passed North Carolina budget gives to a new Medicaid Reform Advisory Group (http://ncleg.net/Sessions/2013/Bills/Senate/PDF/S402v7.pdf p. 161-62):

SECTION 12H.1.(a) The Department of Health and Human Services, Division of Medical Assistance, (Department), in consultation with the Medicaid Reform Advisory Group created by subsection (e) of this section, shall create a detailed plan for, but not implement, significant reforms to the State’s Medicaid Program that shall accomplish the following:

  • Create a predictable and sustainable Medicaid program for North Carolina taxpayers.
  • Increase administrative ease and efficiency for North Carolina Medicaid providers.
  • Provide care for the whole person by uniting physical and behavioral health care.

The class is going to function as an alternative, Medicaid Reform Advisory Group.

The first order of business when we meet for this first time tomorrow night is to decide if there are any other goals/charges that should be added to the work of the group?

I will be suggesting one more:  identify a means of providing a straightforward means of paying for health care for as many North Carolinians as possible.

Below is a link to a series of questions that I have posed to the group to help them organize themselves into functioning units. This is important work, and it should be fun as well. If you have additional questions they should address, post them in the comments.

Medicaid Practicum Course.Topics.8.26.13

Cool new class for Fall 2013–The Future of Medicaid in N.C.

I am teaching a new practicum course in the Fall in the Duke Sanford School of Public Policy for Masters students called N.C. Medicaid and The Affordable Care Act. So far, 13 students–all of whom I have taught health policy and who have previous work experience in health care and who are doing Summer health policy internships–will be working together in teams to consider the future of Medicaid in North Carolina and to propose a plan for its long term reform.

The class will pose three questions to students:

  • Should North Carolina undertake the expansion of Medicaid that is authorized by the ACA?
  • What types of reforms are needed in the current Medicaid program?
  • What role should Medicaid play in the future health care system in North Carolina?

The exciting part about the course is that it will be action oriented as opposed to me simply talking; the students will work in teams to work through these questions and the end product of the class is meant to be a comprehensive plan outlining their preferred strategy for moving North Carolina’s Medicaid program ahead. I certainly have many ideas, but this is not a scripted event where they restate all the things that I think. We will meet together as a work group that is engaged in a vital project, with the goal of producing a report that could actually be useful to the ongoing debate about the future of Medicaid in North Carolina. This is a nontraditional course, and I appreciate the willingness of School of Public Policy at Duke to allow me to try out this new course and format. Stay tuned.

I will blog lots more about this class in the coming weeks.