As we’ve discussed before, Mission Health — the largest hospital system in Asheville, has ended its contract with Blue Cross and Blue Shield of NC effective Oct. 5, 2017. Why? Because Mission is requesting higher rates that Blue Cross NC says would contribute directly to premium hikes for its customers.

But why the higher rate requests in the first place? Well, like all healthcare-cost related issues — it’s complicated. But, one major sticking point for Mission has been the state’s lack of Medicaid expansion under the Affordable Care Act.

Mission’s CEO, Ronald Paulus, has repeatedly argued this point over the years.

In early 2013, in an article titled “Hospitals: Block of Medicaid expansion jeopardizes care in NC” Paulus said that the lack of Medicaid expansion means that Mission must shift costs to paying patients. Basically this means that insured patients, such as those with Blue Cross NC, are taking on the extra costs that uninsured patients can’t pay.

“We understand that the full scope of the Affordable Care Act is incredibly large and very complicated,” Paulus said. “(But) . . . one of the few offsetting benefits was supposed to have been Medicaid expansion… hospitals will have no option but to shift the cost to employers, putting strain on the critical businesses that drive our economy.”

Later that same year, Mission announced layoffs. What did Mission blame, in part? You guessed it — the lack of Medicaid expansion.


Slide from Mission Health’s “SCOPE Live” September 8, 2015

In 2015, Paulus noted several reasons for getting behind Medicaid expansion saying that:

  • 313,000 more people would have insurance if Medicaid were expanded.
  • The state uninsured rate would fall by 31 percent.
  • Uncompensated care would fall by roughly half a billion dollars.
  • 45,000 fewer people would have trouble paying their bills.
  • North Carolina would lose $3.7 billion in federal funding in 2016.

“We pay the taxes, but the money goes to New York and California and other states that have expanded Medicaid,” he finished.

Paulus said that North Carolina’s decision not to expand Medicaid would have brought more federal dollars to the health system.

The theory was more people will get insurance, so you need less payment for the non-insured people,” he said. “But our state chose not to expand Medicaid … so we got all of the cuts and none of the benefits that we were supposed to get.”

Last year in a Mission Health employee town hall, Paulus brought up the lack of Medicaid expansion again as a source of Mission’s growing costs. (Talk about beating a dead horse!)

He encouraged his employees to use their votes to show legislators they want Medicaid expansion.

It’s safe to say that Paulus has made himself pretty clear on the Medicaid expansion issue.

While we know Mission Health’s stance on the lack of Medicaid expansion – and their belief that the solution is to have paying patients potentially pay for any shortfalls – we want to know yours. Comment below or write us on Facebook to let us know if you think the lack of Medicaid expansion is contributing to the soaring healthcare costs in North Carolina.

One thing that IS contributing to higher healthcare costs in North Carolina? State-based mandates that drive up the prices of insurance — for everyone. We want to help us roll them back? Join us.

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