Medical students make voices heard in N.C. Medicaid reform debate

More than 300 medical students representing every medical school in the state made their voices heard as they signed a petition letter to Governor Pat McCrory and the Medicaid Reform Advisory Group expressing their support for Community Care of North Carolina in the Medicaid reform debate.

The letter also expressed concerns surrounding current reform proposals and the effect they may have on attracting and maintaining current and future physicians in North Carolina. Several UNC students attended the Medicaid Reform Advisory Group meeting on Jan. 15 in their white coats and presented the letter and their unique perspective to the reform group and meeting attendees. 

As the Governor and state legislature contemplate and debate changes to N.C.'s current Medicaid system, advocacy organizations, medical societies, and managed care companies are not the only groups taking notice. Medical students from across the state have been paying close attention to the rhetoric, proposals, and concerns surrounding Medicaid and decided it was time to make their voices heard. What started as an idea by two fourth-year UNC medical students in late November, turned into a letter to our state representatives and more. In brief, the letter expressed an understanding of the complexity and magnitude of reform efforts, but made it clear that students believed building on the foundation of Community Care of North Carolina was essential to success:

“To this end, we ask that you strengthen the state’s relationship with Community Care of North Carolina (CCNC) to help manage the health of North Carolina’s Medicaid population. As a physician driven, not-for-profit organization with a history of delivering high-quality and cost-effective care to the citizens of the state, CCNC gives us reason to be proud of our state’s Medicaid system. Your support for this organization would send a message to medical students in this state, as well as around the country, that North Carolina is committed to fostering one of the most innovative, successful medical communities in the United States.”

Though many have come forward in the Medicaid debate in support of Community Care of North Carolina, the students added their unique voice and expressed a concern rarely raised in the debate; changes in the system now may have a significant effect on the physician workforce of tomorrow:

“We also worry that losing CCNC would diminish our ability to retain medical graduates of North Carolina and attract new trainees to practice in North Carolina, especially much needed primary care providers. As future physicians, not only do we look forward to the support CCNC would give us and our patients, we also want to work within a groundbreaking and nationally recognized model for health care improvement. Eliminating support for CCNC would hurt North Carolina’s reputation as a center for health care innovation and lessen its appeal to new medical graduates."

With this letter as the students’ unified message, a multi-institutional, entirely student-led grassroots effort began, raising awareness of the issues surrounding Medicaid's future in the state and serving as an opportunity for other students to add their voice.

By the morning of Jan. 15, the day of the Medicaid Reform Advisory Group meeting, more than 300 medical students from all five medical schools in the state had signed the letter. The letter was presented to the Medicaid Reform Advisory Group by four students in white coats accompanied by a patient story of CCNC's success and a short list of additional comments from signees expressing their personal views on reform.

Many of these 300 medical students have pledged continued involvement in this process and several students at UNC have committed to restarting a Health Policy Interest Group to promote interest and facilitate future advocacy. “We are so excited about this letter, but if we don’t continue to engage with the legislature, we are in danger of practicing advocacy tourism," said Laura Cone, Co-President of UNC Health Policy Interest Group. "We want to develop long term relationships with our state’s leaders so we can better affect change and advocate for patients that rarely have a voice."

In the coming months, the Department of Health and Human Services and the five-membered Medicaid reform advisory group will present a proposal on Medicaid reform to the legislature.

There will surely be at least 300 medical students awaiting the outcome.