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Consumer organizations have asked the Obama Administration for months to give people who find out during tax filing season that they owe a penalty for not buying health insurance another chance to enroll. Today Health & Human Services announced that they will do just that.

In meetings and public forums we have found that many people are confused about whether or not they will be fined for not having coverage. We, along with other consumer advocates, knew that thousands of folks will find out about the penalty when they file taxes. Before the announcement today, that would have been too late, as open enrollment for health insurance ended February 15.

In federal marketplace states like North Carolina this special enrollment period will run from March 15 to April 30 for those who are uninsured and learn that they must make the shared responsibility payment.

Here are additional parameters as outlined by HHS for taking advantage of this new enrollment opportunity:

  • Currently are not enrolled in coverage through the FFM for 2015,
  • Attest that when they filed their 2014 tax return they paid the fee for not having health coverage in 2014, and
  • Attest that they first became aware of, or understood the implications of, the Shared Responsibility Payment after the end of open enrollment (February 15, 2015) in connection with preparing their 2014 taxes.

This is good news for North Carolinians and will help ensure that we aren’t penalizing people for not having reliable information.

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GovBeshear_300Today in the Joint Appropriations Committee at the NC General Assembly there was a suggestion that closing the insurance coverage gap in states has proven much more expensive than first anticipated. Just after the conclusion of our legislative meeting Kentucky Governor Steve Beshear held a press conference addressing this very issue. In his statement to the media Gov. Beshear said claims that Kentucky could not afford Medicaid expansion have been “buried under an avalanche of facts.”

He went on to say:

An avalanche of facts that demonstrate to the satisfaction of anyone and everyone with an open mind that Kentucky can indeed afford to take care of its people. In fact, we can’t afford not to do so.

The focus of Gov. Beshear’s press conference was a new report from the Urban Studies Institute at the University of Louisville showing that the first year of expansion saved millions of dollars and created thousands of jobs in Kentucky. In addition, health care providers were paid an addition $1.16 billion for services.

The report also shows that for the FY17-18 state budget Kentucky will pay a biennial total of $247.6 million for expansion, which will be offset by $511.8 million in savings and additional tax revenue.

We have similar studies in NC showing that covering 500,000 more people would create jobs and boost state revenues. We just need more policymakers willing to listen to the facts flowing from states that have already made the wise decision to invest in the health of their people.

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NC Left Me OutA group of coalition partners working in North Carolina to close the Medicaid coverage gap has launched a new website called NC Left Me Out to collect stories of people who make too much for Medicaid and too little for private insurance. As the website explains, the Affordable Care Act specifically allocated funds to provide affordable insurance coverage to approximately 500,000 people in our state. Unfortunately, the Governor and the legislature have blocked those funds from coming to North Carolina. Many of the individuals and families who could use this money to get insurance coverage work in low-wage professions like construction, day care, and food service.

At a press conference today Dana Wilson, a woman in the coverage gap who suffers from MS, shared her story. You can watch her video here.

The legislature and the Governor need to hear from more people like Dana, the working poor who are being unfairly denied coverage. If you are in the coverage gap please consider sharing your story on the NC Left Me Out website. If you want to support the campaign then you can sign up as well.

Every week a new Governor shows the leadership to formulate a plan for extending insurance coverage to people in the Medicaid gap. Last week the conservative state of Indiana had a plan approved. States like Wyoming and Utah are moving forward with similar ideas. We need Governor McCrory to show us his plan for closing the coverage gap. He has publicly hinted that he wants to design a state-specific Medicaid waiver. Great, let’s get moving. Every day that we wait is another day people like Dana suffer.

We need to continue telling our stories to the media, to legislators, and to the Governor. If the economic arguments and moral arguments don’t win the day, maybe looking into the eyes of those who have been denied coverage will begin changing minds.

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We have written before about King v. Burwell, the case that will be heard before the US Supreme Court to determine whether or not health insurance subsidies can flow to states that refused to establish state-based marketplaces under the Affordable Care Act. As John Stewart has noted, justices would have to be more literal than Amelia Bedelia to find for the plaintiffs, but we live in strange times where anything seems possible.

The next question then is if the Supreme Court strikes down subsidies how many people would it impact? Now Kaiser Family Foundation has a helpful interactive map to estimate an answer. KFF researchers think more than 13 million people nationally, and about 1 million people in North Carolina, would lose tax credits if the Supreme Court denies subsidies to federal marketplace states. For most of these folks insurance would immediately become unaffordable. This is especially true because prices would most likely spiral upward as younger, healthier enrollees lose coverage.

That is a stunning figure. It would be like the Supreme Court cutting the number of North Carolinians receiving Medicare in half.

The cruel truth is that Congress could easily fix this problem by adding a few words to the Affordable Care Act, but they are so obsessed with repealing the legislation that they are unlikely to repair it. The state legislature could also provide a patch by at least establishing a governance structure for a state-based marketplace, but they are also unlikely to move. After all, the federal government stands ready to pay the state to expand insurance to 500,000 more state residents and that hasn’t gained any legislative traction.

So, we wait, while medical care for 1 million North Carolinians hangs in the balance.

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As noted below, Gov. McCrory met with President Obama to discuss flexibility in using Medicaid expansion money to implement a North Carolina specific program that will extend health insurance to more low-income residents. As we have also said, the federal government has shown a tremendous willingness to accommodate governors who request authority to design new and innovative programs. This is all encouraging and kudos to the Governor for sticking his toe in the water.

What is not encouraging is McCrory floating the idea of work requirements as a condition to receive health insurance. As McCrory notes in the article, Utah’s Governor has pushed this idea unsuccessfully. Our Governor feels that President Obama may reconsider his opposition to this idea. That will not happen.

As background, an 1115 waiver allows states to waive some traditional protections in Medicaid to experiment with new ideas that can improve this important health insurance program. Specifically, waivers are meant to promote the ultimate objectives of Medicaid. Several states, for example, now have waivers to purchase private insurance plans for low-income people who would be eligible for Medicaid under expansion. This is an interesting and worthwhile experiment and we will collect important information on outcomes and costs from these state innovations.

Some Governors are abusing this process by applying for 1115 waivers that do nothing but erect barriers for people who need health insurance. A prime example is requesting a waiver that requires people to report to work search programs as a condition of receiving health insurance benefits. This is not innovative. It is not new. We know what happens when you include work requirements as a condition for receiving public benefits. It means many people will not be able to access insurance.

The waiver approved in Pennsylvania includes a provision that automatically refers unemployed people to job programs when they enroll in insurance. That’s fine as long as insurance is not contingent on participation in the work program.

We know, for these reasons, that a work requirement will not be approved by the federal government. There is some concern that Gov. McCrory may use this as a poison pill to sink a Medicaid expansion proposal and then blame the Obama Administration for not showing enough flexibility. Let’s hope that’s not the case.

Gov. McCrory has plenty of room to create a North Carolina specific plan to cover low-income people in the state. He should drop this one idea that everyone knows will never get approved and move forward with an evidence-based, innovative policy.