Context is key for understanding Insurance Commissioner’s Affordable Care Act comments

Many people were surprised to see a story in the News & Observer today where Insurance Commissioner Wayne Goodwin seems to be giving support to opponents of the Affordable Care Act. The article is about a letter that Goodwin sent to federal Health & Human Services Secretary Sylvia Burwell about problems in the North Carolina insurance market.

To understand the letter context is important. Commissioner Goodwin previously raised concerns about implementation of the federal Affordable Care Act with Sec. Burwell at a national meeting and she asked that he put all of his worries about the insurance market into a letter. This is not Goodwin’s broad thoughts on health reform. Instead it’s addressing immediate problems he sees for the stability of insurance companies and agents.

Another critical bit of context is that many of the stumbling blocks cited in the letter are the result of North Carolina not fully implementing the Affordable Care Act. By not establishing a state exchange and by declining to expand Medicaid, Commissioner Goodwin is left helping to steer a half-built car. Not surprisingly, we are hitting bumps. It’s understandable that while he is getting jostled the Commissioner is focused on the potholes. Insurance companies are upset that they are getting some unhealthy customers. Insurance agents and brokers are upset that insurance companies are limiting commissions. Consumers, especially those who don’t qualify for subsidies, are upset about rising premiums. All sides are demanding action from Goodwin but the state outsourced his authority to Washington, DC. That’s why he wrote the feds.

Having said all that, his letter is still perplexing. Perhaps he felt an alarmist tone was warranted because he wanted to get Washington’s attention. He notes, for example, that fewer insurance companies are offering plans now than before implementation of the Affordable Care Act. True enough, but many of those insurance companies weren’t even actively selling plans and had nearly nonexistent enrollment numbers. Blue Cross Blue Shield of NC wrote almost all of the individual insurance policies before the ACA. Now BCBSNC has seen it’s market share diminish as other companies offer meaningful competition.

It’s also true that BCBSNC reported a financial loss last year as medical claims increased by $1.4 billion from the prior year. But revenue at the company also increased $1.6 billion. Losses in Medicare Advantage plans and taxes produced a net loss for the company. It was, by the way, the company’s first year in the red in more than a decade. By their own admission this wasn’t surprising given the market uncertainty right now. That’s why BCBSNC maintains a comfortable reserve. Not many industries can claim such a unbroken stretch of profitability.

Also, North Carolina is nearing 600,000 enrollees in Affordable Care Act plans and our uninsured rate is dropping.

In sum, this letter is not the Insurance Commissioner’s considered opinion of health reform; instead it is a cry from the Commissioner that the state took his steering wheel and he could use a little help righting the car.


Independents and Republicans in NC support closing the coverage gap

A new poll from the nonpartisan organization NC Child shows that a large majority of North Carolinians support closing the health insurance coverage gap that was created when the Governor and legislature declined to use available federal funds to expand Medicaid eligibility. This support extends to Independents and Republicans. The poll found that overall 72 percent of North Carolinians support closing the coverage gap. Among the Independents who often make the difference in close elections support is 62 percent. The same percentage of Republicans want to close the gap.

You can read the analysis from NC Child here.

We know that support or opposition to closing the coverage gap can depend on how you ask the question. This poll was a pretty straightforward description of the Medicaid gap and the policy option before the Governor and legislature. Here’s how the poll was worded:

In North Carolina, more than 350,000 adults, most of them working, cannot afford health insurance on the wages they are paid in industries like retail, construction, and food service. Their incomes are too low to qualify for the tax credits available through the Affordable Care Act and too high to qualify for Medicaid. They are stuck in the ‘insurance coverage gap.’ The Legislature and Governor McCrory could fix the coverage gap by creating a special North Carolina plan in partnership with the Federal government. Do you think North Carolina should make a plan to fix the health insurance coverage gap, or not?

We’ll have to see whether this changes the minds of political leaders. After elected officials in a number of conservative states saw similar polls and watched federal funds flow to other regions they decided to take action to protect their residents and boost rural health care. Let’s hope our politicians have a similar reaction.


This Halloween we’ve had enough of ACA ghost stories and scare tactics

Action NC policy and public affairs director Kevin Rogers has an opinion piece in the News & Observer arguing that the ACA is here to stay, so we should get down to the business of improving the law and fully implementing it in North Carolina.

Open enrollment, he reminds us, starts November 1. Our state is a national leader when it comes to signing up residents for Affordable Care Act plans. The many people who have these policies need added protections, not repeal votes, to make their insurance plans work better. And the working poor need our state leaders to stop blocking Medicaid expansion. This interposition is causing great pain, and unnecessary deaths, all across North Carolina.

You can read the entire editorial here. Rogers concludes with this message to lawmakers:

As we enter the third ACA enrollment period, it is high time for Congress and the General Assembly to accept reality, abandon partisan tricks and move forward to improve the economic and human well-being of our state. Until then, thousands of lives will be lost each year, and billions of dollars wasted that health care consumers, taxpayers and our government cannot afford. The ACA is here to stay – it’s time to start acting accordingly.

If they heed his advice that would be sweet indeed.


Voters in battleground states say the ACA is here to stay

The following is a press release from our friends at ActionNC about powerful polling that shows most voters in battleground states want to move on from the obsession with repealing health reform to a mature discussion of how to improve the law. After more than five years the Affordable Care Act is getting some age on it, and we have learned important lessons from implementation. But we can’t make the law better if lawmakers don’t first accept that it’s a law that is here to stay. As usual, the public has to lead our leaders.


October 7, 2015

Contact: Kevin Rogers, 919.862.4009

Survey Shows that Voters Believe “ACA is Here to Stay”
Elected Officials Need to Improve Law; Not Repeal It

(Raleigh, NC) — A new survey shows that the majority of likely voters in five key battleground states – Florida, Nevada, Ohio, Pennsylvania and Virginia – believe the Affordable Care Act is here to stay (64%) and that Congress should work to improve the law (71%).

The survey, which was released by Community Catalyst and Service Employees International Union (SEIU), found that likely voters prefer a candidate who will work to improve the law over one who would repeal it (55% vs. 40%). Most agreed elected officials should “stop wasting time” trying to repeal the law (58%) and instead focus on a variety of improvements to lower the cost of care.

“These research findings confirm what we continue to hear over and over across North Carolina. People are frustrated with repeated efforts to repeal the ACA. It’s time to recognize that the law is here to stay.” said Kevin Rogers, Policy Director for Action NC. “We need to move forward to find ways to continue to lower health care costs for people and address issues such as high copayments and escalating drug prices.”

“Voters understand that the law has led to some important outcomes such as guaranteeing coverage for people with pre-existing health conditions. This research shows that they now want their elected officials to work together to make improvements that favor patients over insurance companies and pharmaceutical companies,” said Rogers.

The survey showed strong support across party lines for improvements that are being considered to lower health care costs, including:

  • Require hospitals and other health care providers to be transparent about their prices so people understand what the cost of services will be before they use them (75% strongly support)
  • Change the way insurance companies pay doctors and hospitals to create incentives to keep people healthy rather than paying providers based on the number of tests and procedures they give (64% strongly support)
  • Give Medicare the power to negotiate drug prices (63% strongly support)
  • Expand tax credits to small businesses to help the afford employee health insurance (61% strongly support)
  • Give state insurance commissioners more authority to push back on insurance companies that want to hike up insurance premiums (57% strongly support)

The survey was conducted by PerryUndem Research/Communication September 15-19, 2015; 1,005 adults who said they were likely to vote in the 2016 elections and have a history of voting in the 2012 or 2008 elections responded. The margin of error is +/- 3.1 percentage points.

You can read more about the poll results here.


Medicaid reform timeline highlights need for expansion

You should read our earlier post about Rep. Nelson Dollar’s excellent objections to Medicaid reform. Dollar deserves kudos for pointing out that our system is not broken.

Despite these objections the legislature is charging ahead. If we want reform, however, the state needs to expand Medicaid at the same time. Why? Because to reform Medicaid we need permission from the federal government. According to the bill passed by the General Assembly we will officially seek this permission from the federal government by June of 2016. The Obama Administration is unlikely to make privatizing our Medicaid program a major priority in its last few months of office. That is not the sort of legacy he is interested in leaving.

If we do not get approval from the current leadership at Health & Human Services then North Carolina will need to wait until a new President takes office. Then the new President will have to nominate an HHS Secretary and we will have to wait for the Secretary to be confirmed. At some point after that HHS will begin to review our reform proposal.

Alternatively, North Carolina could include expansion in the reform plan. Then the Obama Administration would act quickly to approve our waiver. Certainly HHS is not excited about dismantling our model Medicaid system, but they could live with legislative changes if it meant covering 500,000 more people in our state.

With expansion reform will move quickly and our proposed changes will be accepted by HHS. Without expansion reform will be a long, long road to an uncertain destination.