Legislators dive into health care

By Scott Mooneyham | May 13, 2013

RALEIGH -- State lawmakers may well have spent as much as 20 percent of this year's legislative session diving into health care-related policy. Early in the year, legislators made the much-discussed and ruminated-upon decision to block Medicaid expansion, even as the federal government said it would pick up the full tab for three years.

Since then, they have plowed into certificate of need laws, a system intended to prevent hospitals and other health care providers from dumping money into duplicative services but that critics charge stems competition. There has been debate over cancer drug and Alzheimer's insurance coverage, insurer contracting rules, hospital billing rules, abortion restrictions, the role of midwives and nurses in medicine, and dozens of other health-care related proposals.

Down the street, the administration of Gov. Pat McCrory has proposed a major overhaul of the Medicaid program, pushing the notion that bringing in more private companies to administer costs will better help to control those costs. Behind many of these Republican-backed proposals is a philosophy that state policy should promote more efficiency and foster more competition in health care. It's a laudable goal. Creating more competition in health care, even if it goes against a 50-year trend in the other direction, is one means of trying to hold down escalating costs. It is also noteworthy that the legislation is being considered as the federal Centers for Medicare and Medicaid Services released information showing wide disparities in the prices charged by hospitals. To some degree, though, lawmakers may be spinning their wheels.

One reason is that these proposals are being pursued against the backdrop of extensive changes being mandated as a part of the federal Affordable Care Act. Because of a lot uncertainty surrounding the federal law, not the least being how those changes will affect indigent care and who will actually receive coverage through new federal health care exchanges, it becomes difficult to predict the results of altering state policy. Another reason that some of these legislative efforts may be for naught is that they come amid growing hospital and health care industry consolidation UNC Hospitals recently completed a merger with High Point Regional Medical Center and has entered into partnerships with two community hospitals. Other consolidation includes Greensboro-based Cone Health System taking over Alamance Regional Medical Center. Federal officials have been examining whether consolidations here and elsewhere might create anti-trust issues, but have shown little inclination to stop the mergers. The result, for North Carolina policymakers, is that they are likely to be revisiting these issues again and again for the next several years. Any legislation passed this year will probably face tweaks and changes in subsequent years. If, in 2013, legislators are spending more time than ever drilling down into health care policy, then 2014 and 2015 will likely see new highs in legislative time spent on the subject. The question to be answered is whether North Carolinians will be the better for it.