Professor Mark Hall tells Charlotte NPR station N.C. Medicaid overhaul model could be good for consumers

Photo of Professor Mark Hall

Professor Mark Hall

Professor Mark Hall, director of the law school’s Health Law and Policy Program, was interviewed by the Charlotte NPR affiliate WFAE 90.7 about his opinion on the Medicaid overhaul that was to be voted on by North Carolina lawmakers on Tuesday, Sept. 22. You can find the original article here, on the WFAE 90.7 website.

The original report follows: 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 Gov. 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.

Professor Hall is the Fred D. & Elizabeth L. Turnage Professor of Law one of the nation’s leading scholars in the areas of health care law, public policy, and bioethics. The author or editor of twenty books, including Making Medical Spending Decisions (Oxford University Press), and Health Care Law and Ethics (Aspen), he is currently engaged in research in the areas of heath care reform, access to care by the uninsured, and insurance regulation. Prof. Hall has published scholarship in the law reviews at Berkeley, Chicago, Duke, Michigan, Pennsylvania, and Stanford, and his articles have been reprinted in a dozen casebooks and anthologies. He also teaches in the University’s Graduate Programs for Bioethics and its MBA program, and he is on the research faculty at the Medical School. Prof. Hall regularly consults with government officials, foundations and think tanks about health care public policy issues.