Author

Uncategorized

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.

 

Uncategorized

120px-Tom_Barrett_talking_with_construction_workers

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.

Uncategorized

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.

 

Uncategorized

The Supreme Court Ruled One Way - Here's How You Fight BackThe US Supreme Court decided today that “closely held” corporations that object to contraceptives on religious grounds can deny this preventive coverage to female employees. There will be a great deal of constitutional banter on this opinion but, not being a constitutional scholar, I will make a few practical points.

First, when HHS wrote this popular regulation ensuring that women have access to preventive health care, the department looked to what most states require as a guide. North Carolina, along with a majority of states, mandate that health plans cover contraceptives. Our state has a reasonable exemption for religious employers, and HHS included a similar exemption in its regulations. I hasten to add that, despite this state law, few employers have argued that our state is impeding their religious freedoms.

Second, if you read the Supreme Court decision the majority opinion spends strikingly little time examining the possible impact on women. Instead, Justice Samuel Alito spends most of his space arguing that corporations are people and should enjoy the same religious rights and freedoms as individuals. In contrast, Justice Ruth Bader Ginsberg spends a great deal of time balancing the claims of the Hobby Lobby owners with the health care needs of female employees.

Third, this opinion opens the gate to whittle away many types of preventive health coverage mandates. Justice Alito says that each of these requirements will have to undergo its own analysis and that the current decision is narrowly tailored, but Hobby Lobby certainly invites a great deal of mischief. We will find out in the coming months and years just how deeply this court is willing to cut into protections for women and families.

Here are some initial links to analysis of the Hobby Lobby decision: ThinkProgress, the National Health Law Program, the American Academy of Pediatrics, and TalkingPointsMemo.

 

Uncategorized

In a good conversation with Becki Gray yesterday on News 14 we discussed the different visions for Medicaid reform proposed in the respective budgets of the Governor, House, and Senate. In particular, Gray, who works for the John Locke Foundation, noted that the state has a “rich” benefits package in Medicaid because we offer many optional services, that is, services that are not required to be covered by the federal government. The Senate, she correctly pointed out, wants to whittle away these optional services.

Ending optional services in Medicaid is a popular policy among conservative think tanks in the state. Apparently the Senate is listening.

As this debate progresses it is important that we know what services we are talking about when we talk about optional services. Let’s review a few: transplants, prescription drugs, dentures, hospice, prosthetics. None of these treatments are frivolous or lavish.

And that’s the trouble with optional services. If you want to get at some of the more expensive options then you are limiting life-saving care. Former Locke Foundation analyst Joe Colletti even praised Arizona for cutting optional services like transplants in a report on Medicaid reform. But these cuts inflicted so much pain in Arizona that the state made a volte-face on its decision.

That brings us to the Senate budget. Among other things the Senate wants to end the optional Medically Needy program in Medicaid. This program allows people who have enormous medical expenses, but earn too much to qualify for Medicaid, to apply these medical bills to their income to access Medicaid. This makes sense. If, for example, you earn $30,000 per year but need expensive drugs or nursing home care then these costs will quickly eat through your monthly income. Although you may have some money your medical needs erase it all. It’s not fair to tell this person that he or she is too wealthy for Medicaid when they effectively have nothing.

But this is exactly what the Senate aims to do.

As we have said many times before, “optional” refers to a regulatory requirement and does not mean anything about the necessity or quality of specific Medicaid services. You may call it foolish for the state to cover optional services. I call it basic human decency.