NORTH CAROLINA FOLLIES

North Carolina's Medicaid program offers such top-of-the-line coverage that officials worry patients are moving here to take advantage of it. The state's Medicaid program, which covers the disabled, poor and aged who qualify, pays for more services than 33 other states provide to their Medicaid patients. North Carolina pays for psychologists, private-duty nurses, dentures, personal care services and other benefits not offered by many states. The state also pays doctors more than 44 other states.

The N.C. Senate earlier this month passed a budget proposal, now being reworked in the House, that makes cuts in both services and physician reimbursements. It's an attempt to temper the program's rising costs in the state budget. "North Carolina has been spending far more on Medicaid than the rest of the Southeast," Democratic Senate leaders said in a recent budget briefing paper, "which has encouraged people from other states to come here under false pretenses for services."

State and local Medicaid officials can't confirm or dispute that argument, because they don't record a patient's previous address. It's a contention that periodically rises up, especially among border counties. "It's something we hear about anecdotally," said Keith Moon, social services director in Gaston County.

North Carolina's Medicaid budget has ballooned from $4.6 billion six years ago to $8 billion this year. The state's share of that has grown from $1.3 billion six years ago to $2.3 billion this year, and helped fuel steady growth in the state budget. Medicaid is health care coverage for certain groups of poor people, mainly the disabled, elderly and single-parent families who fall below certain income levels. The federal government carries 66 percent of the cost, the state's share is 29 percent and the counties pay 5 percent. Legal aliens or refugees are eligible for Medicaid but only after a certain period of residency or for a limited time. Illegal aliens are eligible only for emergency medical services.

By 2010, Medicaid is projected to consume 30 percent of the N.C. budget. "You're serving a group of people with benefits that exceed, in many cases, what they would receive on a private (insurance) policy," said Senate President Pro Tem Marc Basnight, a Democrat from Manteo. "The care level is rightfully generous in this state, but something that we can't afford. ... We're unable to pay at the rate that we're paying."

Lanier Cansler, a Republican who recently stepped down as the No. 2 official in the N.C. Department of Health and Human Services, said, "Everyone is beginning to understand that Medicaid isn't going to be sustained as it is." ...

The General Assembly in 2001 commissioned an extensive review of the state's Medicaid program by The Lewin Group, a Virginia-based consulting firm. Lewin's report said North Carolina included several benefits "not offered by an overwhelming number of state Medicaid programs." One of Lewin's primary recommendations was considering "whether North Carolina should pare back where it exceeds the `average' state Medicaid program."....

The state budget passed by the Senate, and now being rewritten by the House, made several cuts in Medicaid, including: Reducing personal care service from 60 hours per week to 40; Dropping physician payments from 95 percent of the Medicare rate to 90 percent; Lowering payment for private-duty nurses from a maximum of more than $300,000 to about $80,000 annually; Shifting 65,000 aged, blind and disabled Medicaid patients who are eligible for Medicare to that program.

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Illinois: Conscription for pharmacists: "The American Center for Law and Justice (ACLJ), which specializes in constitutional law, today filed an amended complaint in state court in Illinois adding four additional pharmacists to its lawsuit challenging Illinois Governor Rod Blagojevich's emergency amendment to the state code requiring pharmacists to dispense medication even if filling the prescriptions violate their conscience and religious beliefs. The ACLJ initially filed suit in mid-April on behalf of two pharmacists and today's action brings the total to six pharmacists who contend the Governor's order is unenforceable. 'The Governor's directive continues to cause concern for a growing number of pharmacists who don't believe they should have to put their religious beliefs aside to keep their jobs,' said Francis J. Manion, Senior Counsel of the ACLJ, which is representing the pharmacists."

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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