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Thom_Tillis_official_portraitWhen I last posted about the Senate debate between Speaker Thom Tillis and Sen. Kay Hagan I had listened to the exchange on radio but I had not yet watched the video. Watching television coverage of the debate one could hardly miss that Tillis was, once again, wearing a blue lapel pin from the science and advocacy organization Autism Speaks.

The pin highlights an important question that the media and voters should be asking Tillis: Where does he stand on minimum coverage requirements for insurance?

The primary argument Tillis pushes against the Affordable Care Act and Sen. Hagan is that the health law set a new floor for health insurance benefits. That’s why some plans were initially cancelled. It’s why some plans cost more than before the enactment of reform. But for the Autism community setting minimum standards for insurance was one of the most important parts of the Affordable Care Act. In fact, Autism Speaks and the Autism Society are still doing critical work to ensure that insurance companies are adhering to these new mandates.

Moreover, Tillis personally advocated for a bill expanding on the minimum requirements set by the ACA by mandating insurance coverage for the diagnoses and treatment of Autism Spectrum Disorder.

Assuming that Tillis was sincere in his support of new insurance requirements it’s difficult to see how he could object to the health reform law establishing similar mandates. And if he supports minimum requirements in general but opposes specific coverage mandates in the ACA then he should specify which services he would make optional for insurance companies. Would he say that insurers can go back to not covering pregnancy? What about prescription drugs?

The answers to these questions cut to the core of the Speaker’s opposition to health reform and voters need to know where he stands.

Commentary

As expected health care played a major role in the first debate between Sen. Hagan and Speaker Tillis.

Tillis took two major lines of attack against Sen. Hagan on health care: he chastised Hagan for saying that people could keep the insurance plan they like, and he criticized the policy of setting minimum standards for insurance plans. He also mentioned at the end of the debate that people will pay 11 percent more for insurance next year but that was a strange sidebar claim with no evidence to support it. Insurance policies are not yet posted and have not even completed regulatory review.

On the first point Tillis chose his words carefully. Koch brother groups in North Carolina keep claiming that thousands of people in the state lost their insurance. The Tillis camp apparently realizes that this is a ridiculous assertion. So Tillis said that thousands of people received cancellation notices from their insurance company. This thrust was parried by Hagan when she pointed out that the plans were continued when she and other members of Congress pressured the Obama Administration to keep the policies in place. She also noted that insurers continued selling non-compliant insurance plans to consumers after the Affordable Care Act was signed without adequately explaining that the policies would have to change after 2014.

On the second point Tillis argued that people should be able to purchase any insurance plan they want without regulations on what is covered. The Affordable Care Act imposes some standards on insurance policies. Hagan didn’t spent much time responding to this charge, although she could have noted that his push for mandating that insurance cover Autism treatments directly contradicts his criticism of health reform. The problem with deregulating insurance is twofold. Read More

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A new report from the Robert Wood Johnson Foundation and Urban Institute shows the financial folly of rejecting Medicaid expansion. Currently 24 states are refusing federal funds to cover more of the uninsured, although that number is quickly dwindling as more governors and legislators get approval to implement state-specific expansion plans. If North Carolina does not act soon we will find ourselves in lonely company.

Here are the numbers. On average, the Urban Institute finds that every $1 invested in Medicaid expansion will bring $13.41 in federal funds to the state. In North Carolina the 10-year cost to expand Medicaid is $3 billion, although the savings and cost offsets mean that the state would actually save money in the budget over that timespan. At the same time our state is losing nearly $40 billion over 10 years by not expanding Medicaid. Hospitals in our state stand to lose $11.3 billion over 10 years, which is why we are seeing layoffs and closures at hospitals across North Carolina.

This financial picture has convinced even rock-ribbed Republican governors across the country to champion expanding coverage in their states. Many of these political leaders from Arkansas to Iowa, Indiana to Utah, are proposing to increase coverage by applying for a Medicaid waiver that allows these states to use federal funding to craft creative alternatives to traditional Medicaid expansion.

Arkansas led the charge on this front by using expansion funds to buy private insurance coverage for low-income individuals and families in that state. And we see that Gov. Mike Beebe certainly hasn’t suffered by doing the right thing. He currently enjoys a 60 percent approval rating compared to 23 percent who disapprove of his policies. Despite being a Democrat his ratings are even above water with Republican voters. Compare this with Gov. McCrory who is having trouble cracking 40 percent in his approval ratings.

Gov. McCrory could add some polish to his image by expanding health coverage to 500,000 more people, bringing $40 billion in federal funds to the state, and boosting hospital bottom lines by $11 billion. Who knows, it may even help the legislature pick its approval ratings up off the floor.

 

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This morning consumer advocacy group Families USA released a report along with the NC Community Health Center Association and the NC Justice Center showing that most people who stand to benefit from closing our state’s health insurance gap are working. Many of these folks are in low-wage service jobs. The report also examines the top occupations in North Carolina where employees would benefit from Medicaid expansion.

There are 59,000 construction workers who would benefit from Medicaid expansion and 56,000 food service workers. When these employees are in good health we are all better off. Construction workers at home with a serious illness and food preparers with untreated diseases decrease productivity and threaten public health.

Chid care workers and home health aides are also disproportionately impacted by our state’s stance on Medicaid expansion, which means that the people who help nurture our children and tend to the elderly can’t take care of their own health needs.

It is a positive sign that Gov. McCrory says that he is keeping the door open to Medicaid expansion in the state. Still, this passive stance will not move us anywhere. If we are going to prevent unnecessary deaths, extend needed preventive care, and help the people who make our food and care for our kids then we need the Governor to lead.

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nci-vol-2174-300The White House Council of Economic Advisers released a report today detailing the health and economic consequences of refusing to accept federal Medicaid money to expand insurance coverage in North Carolina.

If the state accepted federal funds we could provide insurance coverage to 377,000 more people. This influx of federal money would also create jobs and boost our economy. And reducing our uninsured rate would have salutary impacts on the lives of those able to obtain affordable health care.

For example: 27,000 women would gain access to to recommended health screenings; 90,000 people would gain access to a medical home; 50,000 more people would report that they are in good health. The individual financial impacts are no less dramatic. Closing the coverage gap here would mean 17,000 fewer families facing catastrophic medical bills and 53,600 fewer people borrowing money to finance their health needs.

Some claim that North Carolina can’t afford to extend health coverage to more people. When you look at the numbers it’s clear that we can’t afford not to expand coverage. In 2014 the state is giving up $2.7 billion in federal funds. In 2015 that increases to $3.2 billion. In 2016 it’s $3.6 billion. In 2014 we could create 8,700 jobs. In 2015 we could create 19,400 jobs. If a private company or a new military base opened in North Carolina that created 19,000 jobs, politicians would be elbowing each other to get to the ribbon cutting.

The Council of Economic Advisers calls the decision to refuse new Medicaid funds a “missed opportunity.” That’s an understatement; it’s more like a terrible shame.