After two years of debating how to change North Carolina's most expensive health care program, state lawmakers will vote on a Medicaid overhaul Tuesday. The model negotiators settled on is a mix of two previous proposals.
Senate leaders wanted to give insurance companies more control over Medicaid, while House leaders and Governor Pat McCrory favored putting groups of doctors and hospitals on the hook.
Negotiators settled on a model that uses both. Will that create "a Frankenstein's monster?" That's the question Wake Forest professor Mark Hall asked earlier this year.
"We proposed the thought that hybridizing these two separate ideas might be freakish, but in fact, I don't think it is," Hall says. "I think it's actually a very sound and carefully thought-out use of the best of both models."
Hall says the insurance company model is good for controlling costs. The state gives them a budget based on who they serve, and then they're on the hook if they go over.
The doctor-and-hospital model is good for ensuring quality. The federal government has been pushing that model, and it comes with metrics to gauge whether patients are benefitting.
"And the bill also references a sort of cap on the profits and overhead expense that these managed care plans can occur," Hall says. "Both of those are helpful consumer protections, although the quality measures at this point are still unspecified."
Hall says the state health department would work out those details.
The compromise plan upsets some in the medical community, who point out a big part of the state's Medicaid program was already saving money and improving patient outcomes, according to a recent state audit. That part, called Community Care of North Carolina, would eventually go away or change roles under the plan.
Lawmakers are scheduled to take their first votes on it Tuesday.