NC refuses Medicaid expansion and Wilkes County hurts – badly

Screen Shot 2014-04-16 at 10.12.16 AMYou could tell this story in any one of the most rural counties in North Carolina. From the Wilkes Journal-Patriot in a stunning story yesterday:

Over half of the 898 people who contacted a temporary counselor in Wilkes County for help in signing up for health insurance during the first federal Affordable Care Act (ACA) open enrollment period didn’t qualify.

Most of these 512 people unable to get insurance with reduced premiums through the ACA didn’t qualify because their incomes were below the federal poverty level, said Wilkes Health Department Director Ann Absher. Minimum annual income for a single person to qualify is $11,490. It’s $23,550 for a family of four.

Here at the NC Justice Center we hear similar stories every time we go to the more rural parts of our state. Most recently we heard the difficulty health assisters have in Beaufort County when they have to tell people they are “too poor” to get coverage.  It’s easy for Governor Pat McCrory and some NC legislators to be glib about why they refused the billions of dollars in federal money to expand Medicaid under the Affordable Care Act.  But I’d like to require them to have to personally answer the poor, hardworking folks they denied health coverage to this year. Maybe then they wouldn’t be smiling quite so broadly as they are in the photo below.

Medicaid bill sign2 - Version 2

Lower cost projections for Affordable Care Act mean good news for states too

Screen Shot 2014-04-14 at 4.17.51 PMThe Congressional Budget Office (CBO) released the fourth year report on projections of the cost of the Affordable Care Act.  The news is good and consistent with the trend over the previous four years: CBO now projects $104 billion less in costs under the Act than it did last year.  The reduction in costs is due to a variety of factors but two big ones stand out.  First, plans being offered under the health exchanges have significantly lower premiums that were originally anticipated, largely a result of narrower networks of providers and tighter management of health care in the plans – a trade-off that has resulted in big savings.  Second, all health costs – both in government programs like Medicare and Medicaid and in the private sector – are projected to grow  more slowly than just last year.  The CBO points out that this is becoming a trend:

A notable influence is the substantial downward revision to projected health care costs both for the federal government and for the private sector. For example, since early 2010, CBO and JCT have revised downward their projections of insurance premiums for policies purchased through the exchanges in 2016 by roughly 15 percent, and CBO has revised downward its projection of total Medicaid spending per beneficiary in 2016 by roughly half that percentage.

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Medicaid expansion: Life v. Death

imageA popular theme on the Right is that having Medicaid health coverage is worse than having no health insurance at all.  After all the years I’ve spent traveling North Carolina and meeting people in poverty desperate for basic health care but with no way to pay for coverage I still can’t believe people can make this argument with a straight face.  Well, if you read one thing this weekend, read the incredibly moving story of the hardworking mom in Orlando, Florida who would have qualified for Medicaid but hasn’t because Florida, like NC, has refused to expand Medicaid.  She dropped dead – on a sales call for her vacuum cleaner sales job no less – of an existing heart condition she couldn’t adequately treat because she couldn’t adequately pay for coverage.

The business case for Medicaid expansion in NC

Andrew Brod, senior research fellow in UNC Greensboro’s Center for Business and Economic Research, has a great column in the Charlotte Business Journal this week making the strong business case for why NC should accept the billions of federal dollars now available to expand Medicaid.  His reasons are wide ranging from more jobs to avoidance of business tax penalties and even lower rates of personal bankruptcies. Reasons like these are why many conservative states are now moving to close the Medicaid coverage gap – let’s hope NC can be as smart. Read Brod courtesy of the Charlotte Business Journal:

 

Gov. McCrory embracing at least part of Affordable Care Act

I just found this amusing. Remember last month as Governor McCrory’s administration put forward its plans for reforming NC’s Medicaid program with much fanfare?  It was all about “Accountable Care Organizations” or “ACOs” – basically just a different and – possibly – more efficient and effective way to pay doctors and hospitals for delivering care.  ACOs represent incremental, cautious and responsible Medicaid reform. This is much better than selling off our Medicaid program to out-of-state insurance companies, a policy advocated by many ultra-conservatives in our General Assembly, which might give you an idea of how McCrory’s plan is being received.

Anyway, I was at the federal Centers for Medicare and Medicaid Services (the main part of the federal Department of Health and Human Services) website yesterday and what were they highlighting?  The role of Accountable Care Organizations in the implementation of the Affordable Care Act.  Glad to see that McCrory is embracing at least some of the ACA – now, if he could just explain to us how is he going to expand Medicaid and close the NC coverage gap.

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