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At this morning’s presser Sen. Phil Berger said he did not see his chamber expanding Medicaid or supporting a health benefits exchange in any form.

I’ll address Medicaid first. The Budget and Tax Center has written a brief on why the Medicaid expansion is critical. In that paper they explain that Medicaid would provide health insurance to hundreds of thousands of North Carolinians and bring a flood of federal money in to the state, which would boost job creation and support health care providers. It would help hospitals that see a large percentage of uninsured patients, especially in rural areas of our state.

We would all pay for not implementing the Medicaid expansion. The American Academy of Actuaries says that private insurance premiums will increase faster in states that do not expand Medicaid. That is because there will be more cost shifting in those states with higher uninsured populations. It is also because more folks with more health needs will get subsidies to purchase private insurance if we do not expand Medicaid. That will mean the insurance pool will be filled with people who are not as healthy, which will result in higher premiums.

More businesses with more than 50 employees will pay penalties for not providing health insurance if we do not expand Medicaid. Under health reform, if you own a business with more than 50 employees and you do not offer affordable insurance and at least one of your employees gets federal subsidies to purchase private insurance, then you will be fined. If, however, we expand Medicaid then fewer employees will receive a subsidy, which means fewer businesses will get penalized. There is no fee for a business when employees get Medicaid.

On the exchange it was not surprising to hear Berger say that his caucus is not excited about a state-based exchange. But there is no reason at all to reject a hybrid exchange, or, as it is officially called, a state partnership exchange. Having a partnership exchange means that the federal government pays us to conduct our own consumer assistance program and review insurance plans sold in the exchange. North Carolina is a pioneer in the area of consumer assistance for insurance problems. To turn that function over to the federal government just feels unpatriotic. Maybe I’m just too prideful about North Carolina.

It is also good for North Carolina to review insurance plans sold in our exchange. If insurance companies or consumers have questions about plan approval we know the North Carolina insurance commissioner and we know how to contact him. If I had similar concerns in a federal exchange I would have no clue who to call.

Rejecting a partnership exchange is just saying that we want no say over how things operate in North Carolina. I can understand Berger not wanting to take full ownership of the exchange but rejecting a partnership makes no sense at all.

Every day that North Carolina spends running away from health reform is a day that we get further from where we will need to be one day. Putting off decisions now will only increase our pain in the future. States that embrace reform will get all of the benefits while we get left behind.

At an event co-sponsored by the Brody School of Medicine at East Carolina University, the NC Justice Center, and Families USA, Dr. Don Berwick and Ron Pollack will talk about health system reform under the Affordable Care Act.

Dr. Berwick, most recently, ran the Centers for Medicare and Medicaid Services, which oversees nearly a third of health spending in the United States. Partisan gridlock in Washington prevented Berwick from getting confirmed. Berwick is one of the founders and leading figures of the patient safety and health care quality movements. As a co-founder of the Institute for Healthcare Improvement, Berwick worked with thousands of hospitals and health systems across the world to save hundreds of thousands of lives by focusing on quality and coordinating care.

Ron Pollack is the founding executive director of Families USA, one of the nation’s leading health care consumer organizations. Pollack was instrumental in passing the Affordable Care Act, and his organization has produced hundreds of reports over the years documenting the struggles people face when trying to navigate our broken health care system.

The event will begin at 12:15 at the Brody School of Medicine Auditorium in Greenville and is open to the public.

On October 1, 2013, early enrollment begins in the North Carolina Health Benefits Exchange. Our exchange will likely start as a partnership between the state and federal government.

This means that in one year people without affordable employer insurance will be able to easily shop and compare plan options online. And, for the first time in our state, no one will be charged more due to their gender or prior medical history. And subsidies will be available for many of those who are not able to afford coverage.

The health exchange in North Carolina will do much more than host a website. It will also maintain a call center and scatter people throughout the state to help consumers navigate our reformed insurance system. It will also, depending on eligibility, help people enroll in Medicaid and other public programs.

The Affordable Care Act was not an overhaul of how we provide health care in the state. Hospitals are still independently operated and most people will continue getting insurance through an employer or a private company. But the changes coming in one year do represent a tremendous step toward protecting consumer rights and providing new access to care.

Opponents of the Affordable Care Act have yet to give us a viable alternative. They tend to be big on repeal and short on replacement ideas. They are especially short on ideas that deal with pre-existing conditions and extending access to the uninsured.

The truth is that those pushing repeal are defenders of the status quo. And here is an illustrative example of how things work now. A Virginia couple who recently won the Carolina Cash 5 lottery drawing said in the press release:

“I have lots of doctor bills,” his wife Kathy Walker said. according to an N.C. Education Lottery news release. “This money comes at a great time. Hopefully we can save some for the future, as well.”

Right now health care is a lottery. Some people get coverage and some people don’t. If you lose your job and lose your insurance and can’t find coverage due to a pre-existing condition, then you are left with Carolina Cash 5. I, for one, am grateful for reform.

As we have traveled around the state for the last several years discussing health reform, again and again we hear from people frightened of losing their insurance coverage. The problem is that many of these folks have been diagnosed with a medical condition that brands them as uninsurable for life. In 2014 that worry will go away.

Currently, if you are diagnosed with a medical condition and seek insurance coverage you can be turned away or charged thousands of dollars per month for a policy. Health reform put some immediate changes in place as stop gaps for people with these so called pre-existing conditions. New money expanded our state’s high risk pool, called Inclusive Health, which gives people with pre-existing conditions a new coverage option. Young people can now stay on a parent’s insurance plan until age 26. This helps bridge potential gaps in coverage. For someone with a pre-existing condition such a gap can prove financially catastrophic. Children can no longer be denied coverage due to a pre-existing condition. And, starting in 2014, insurers will not be allowed to charge more or deny coverage due to a previous medical diagnosis.

Who will this help? Families took a close look and determined that more than 2 million North Carolinians will get a new sense of security from reform. Nearly one-in-four people in almost every county have been diagnosed with a pre-existing condition. In Wake County, 186,800 people have faced such a diagnosis. In Mecklenburg it’s 190,700. In Robeson County more than 30 percent of the population lives with a pre-existing condition.

These numbers are conservative. This report only shows people diagnosed with or treated for a specific set of medical conditions in 2009. That means the uninsured or those with problems accessing the health care system are undercounted. But this report does show the dramatic scope of the problem in our state. And it shows the tremendous relief health reform will bring to millions of families when it is fully implemented in 2014.