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As we report below the US Supreme Court has decided to hear another legal challenge to the Affordable Care Act.

You can read the details of the lawsuit in our earlier post, but some context is important. This new fight focuses on subsidies extended to individuals and families earning less than 400 percent of the federal poverty level who purchase private insurance. For these families subsidies are available to make insurance plans more affordable. In North Carolina about 91 percent of people purchasing Affordable Care Act plans received subsidies. Of those, the average cost of insurance is $81 per month.

News coverage of the Supreme Court’s move, coming just before open enrollment is set to start, is sure to cause confusion. In the short term it is critical to remember that the subsidies are still in place and everyone should proceed to shop for insurance without worrying about the political winds.

In the long term it is difficult to know what this case will mean for the law. The challenge is absurd, but that doesn’t give us any hint at how the Supreme Court Justices will vote. Read More

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Funeral

Photo: NC NAACP

As the North Carolina NAACP holds a “Denial of Medicaid Funeral Procession” today, it’s worth considering some of the facts and data surrounding the impact of North Carolina’s ongoing refusal to expand Medicaid under the Affordable Care Act:

The North Carolina Institute of Medicine’s 2009 Access to Care study begins with this statement: “The lack of health insurance coverage is the foremost barrier to accessing health care services.”

In the report’s introduction it continues:

In a statewide survey of adults, nearly half of the uninsured in North Carolina reported forgoing necessary care due to cost, compared to 10% of individuals with insurance coverage. Lack of coverage also adversely affects health as the uninsured are less likely to get preventive screenings or ongoing care for chronic conditions. Consequently, the uninsured have a greater likelihood than people with coverage of being diagnosed with severe health conditions (such as late stage cancer), being hospitalized for preventable health problems, or dying prematurely. In fact, adults who lack insurance coverage are 25% more likely to die prematurely than adults with insurance coverage.

A Families USA report in 2010 estimated that before the Affordable Care Act passed nearly 1,000 North Carolinians died each year between 2005 and 2010 due to lack of health insurance.

What has changed is that the states now have an unprecedented tool for saving lives. North Carolina now has the opportunity to extend health insurance coverage to nearly all low-income adults, the majority of whom are working. The federal government will finance nearly the entire cost of this coverage expansion. Not expanding coverage is not only morally misguided but it is also fiscally irresponsible. Read More

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The Alliance for a Just Society along with Action NC released a report today titled “The Promise of Quality, Affordable Health Care for Women: Is North Carolina Delivering?” The answer, in a word, is no.

Overall the report gives our state a C- on women’s health when looking at a range of measures from health outcomes to access. Most abysmal is the state’s ranking on health insurance coverage. There we merited a D-. The uninsured rate among non-elderly women in NC is nearly 17 percent. There are also tremendous racial disparities in uninsured rates. Nearly 19 percent of black women are uninsured in the state, according to the report, and almost 39 percent of Latinas are uninsured. Our state ranks 50 out of 50 for uninsured rate among Latinas.

The grades don’t climb much higher from there. On women’s access to health services we earned a mediocre C and on health outcomes we get a C-. This is a report card we might want to hide in the couch cushions.

But there’s good news that could boost our lackluster scores. As the report recommends, expanding Medicaid would put a major dent in our uninsured rate, help close the health disparity gap, and improve outcomes.

NC lawmakers once famously claimed that Medicaid expansion has nothing to do with women’s health. This report card, and hundreds of thousands of women across the state, beg to differ.

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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