With North Carolina facing an estimated $3.7 billion deficit, our state faces some hard choices. But just because cuts to government services are necessary is no reason to abandon our state values of shared sacrifice and protection of the most vulnerable. As individuals, North Carolinians didn’t create the recession that is the major reason for our terrible budget deficit, but like it or not, it’s time for a solution.
A balanced solution to our budget predicament puts not only cuts to services but revenue raising provisions on the table. Shared sacrifice doesn’t mean cutting the pay of state workers who drive snowplows on the road in front of our house. We all have to contribute too, even in a small way. This means, for example, being willing to forego this year’s scheduled sales tax and high income earner tax cut. Most of us wouldn’t notice at all that we were paying the same sales tax this year as we did last year, but we would notice the newspaper headline announcing that North Carolina’s budget hole just got a $1.4 billion plug.
Likewise, cuts to government services need to be targeted to minimize the impact on our children, elderly and disabled citizens. In the case of Medicaid, North Carolina’s health care program for low-income people, knowing who this health care program serves and what services they get can help us follow our values too.
While politicians frequently trumpet the need to “cut Medicaid,” they rarely point out that children make up 60% of the state’s Medicaid patients. Kids are followed by the elderly and disabled (another 27%), with the last 13% largely parents, pregnant women, and a few other minor categories. And it’s important to know that although mostly kids are on Medicaid, kids are relatively cheap to insure. In fact, we spend most Medicaid dollars on people with serious disabilities and older adults because (surprise!) they have a higher need for health care services.
Some also like to engage in grave talk about the need to eliminate “optional Medicaid services” as a way to reduce costs. The details are important to following our values here too. The bulk of the spending on these so-called “optional” services goes to prescription drugs: take away remedies like antibiotics from the basic health care package we provide would mean delivering 1920’s medical care in 2011. A few of the other major optional Medicaid services include dental treatment, ambulance service, hospice care, artificial limbs, and residential care like group homes for people with mental disabilities. Certainly none is an extravagance.
Smart ways to reduce health care costs in Medicaid would include expanding the reach of our successful primary care case management program in which pediatricians and family doctors are in charge of delivering better health care at lower costs. We could also target unnecessary surgeries as a recent announcement from private nonprofit health insurer North Carolina Blue Cross detailed: patients get less unneeded surgery with dangerous side effects and health care costs are reduced at the same time.
Our budget deficit is one of the greatest challenges we have faced in many years. But we can’t face this challenge either in ignorance of the consequences of our choices or in denial of the values that are the strength of our state.
Adam Searing is the Director of the North Carolina Health Access Coalition