Commentary

Powerful video explains why latest Trumpcare proposal would be a disaster for NC and the nation

On July 28, there was a collective sigh of relief across North Carolina and the U.S. as what was thought to be the last attempt to repeal the Affordable Care Act (ACA) and dismantle Medicaid failed. Advocates were hopeful that our lawmakers in Washington would commence bipartisan efforts to strengthen the ACA and improve Medicaid. Unfortunately, the zombie bill known has Trumpcare is back – this time as the Graham-Cassidy bill. Reports show that more than one million North Carolinians could lose coverage if conservative lawmakers are successful in passing this bill.

Despite its new name, the bill has the same damaging effects on Medicaid – a program that matters to North Carolina’s children, older adults, and people with disabilities. The Graham-Cassidy bill would dismantle Medicaid by restructuring the program from the current federal-state financial partnership in which the federal government pays for 67.6 percent of Medicaid costs to one featuring so-called “per capita caps” that provide a fixed amount per Medicaid beneficiary. In other words, caps are cuts to Medicaid funding. Thus, states will have to make decisions on whether to cut services, the number of Medicaid beneficiaries, or provider payments.

As conservative leadership in DC prepares to cut coverage for millions, they would do well to remember the story of Rev. James Brigman. (see the video below). Earlier this summer, Rev. Brigman walked from North Carolina to Washington to stand, walk, and speak for his daughter Lauren Faith who depends on Medicaid. Lauren Faith’s Medicaid coverage allows her to get the nursing care she needs, but also helps her parents to work. Rev. Brigman and Lauren Faith are just a snapshot on why Medicaid is coverage that should be protected. Tragically, once again, our national leaders are preparing to put families like this in jeopardy.

 

Commentary

New federal data: The ACA works, but would work better if NC expanded Medicaid

Today, the U.S. Census Bureau released state-level health insurance data that prove once again that the Affordable Care Act is working. In a year that has been filled with the White House working to sabotage the ACA and the GOP’s efforts to repeal and replace the ACA, lawmakers now have even more evidence that the ACA has led to significant coverage gains across the U.S.

Nationally, the uninsured rate for the entire year of 2016 is 8.8 percent — down from 9.1 percent in 2015. North Carolina has the same downward trend as the uninsured rate dropped from 11.2 in 2015 to 10.4 percent in 2016. When looking at longer trends in health coverage data, we see that since 2013, 5.2 percent more North Carolinians have health insurance coverage. Considering these historic health coverage gains, lawmakers in Washington need to stop reviving “zombie repeal bills”and focus on market stabilization and strengthening the ACA.

While these data from the Census Bureau give us good news, they also highlight how North Carolina lags behind many other states concerning its uninsured rate. That is because state lawmakers have failed to support bills that would increase access to Medicaid. The state-level data show that the uninsured rate for states that expanded Medicaid is 6.5 percent in 2016 compared to 11.7 percent in non-expansion states. Between 2015 and 2016 the decrease in the uninsured rate in expansion states was 0.9 percent compared to 0.7 percent in non-expansion states.

As North Carolina moves forward with its plan to reform Medicaid, expanding access to the program will make the process truly transformative. There are approximately one million people who remain uninsured in the state, approximately half of whom would finally be able to access the care they need if lawmakers moved forward to close the coverage gap. The proposed program design for Medicaid transformation notes a strategy to address the opioid crisis, but considering that 144,000 people with substance use disorders are in the coverage gap, it will only help some North Carolinians. Reports from expansion states like West Virginia and Kentucky prove that expanding Medicaid helps address states’ opioid crisis. Considering that year after year Census data show how the ACA positively impacts North Carolina’s health coverage rate, it is time for the state’s lawmakers in D.C. and Raleigh to work to strengthen the ACA and fully implement the law by closing the coverage gap.

Commentary

Attention Burr and Tillis: U.S. Senate plan to gut Medicaid would be disastrous for NC moms

While US Senators Thom Tillis and Richard Burr are enjoying their Fourth of July recess, children, working families, veterans, older adults, and people with disabilities are worried that the Senate health care bill — known as the  Better Care Reconciliation Act (BCRA) — will cut their access to health coverage and care.

What is perhaps most troubling about the BCRA are the massive cuts it proposes to Medicaid. The Congressional Budget Office released an addendum to its original report showing that by 2036 federal funding for Medicaid will be 35 percent lower under the plan. There is already lots of in-depth analysis proving how Medicaid matters to our most vulnerable North Carolinians, the state budget, health care workers, and education, but a recent piece that has gained national attention proves that Medicaid matters to mothers.

Specifically, North Carolina’s Medicaid program has been especially important to addressing the longstanding gap between white and black maternal mortality. Even though North Carolina is not an unusual health outcome performer, it is unique in that it has managed to close the maternal death gap between black and white mothers. Community Care of North Carolina works through Medicaid to provide “Pregnancy Medical Homes” so that women who may experience stressors or other risks to a healthy pregnancy and delivery have access to resources and supports to lower those risks.

The success of this Medicaid initiative has actually helped North Carolina improve maternal mortality to the point that is closer to the national average. As Senators Tillis and Burr mull the Senate health care bill, they should also think about efforts state administrators and lawmakers are taking and should be taking to address social determinants of health and reduce health disparities. The state’s latest Medicaid reform waiver application, which has been submitted to the feds for approval, proposes significant improvements in this realm. Unfortunately, If the Senate approves on a bill that includes cuts to Medicaid that will reach $772 billion by 2026, achievements like reducing the maternal death gap will be hard to come by.

Commentary

Trump’s budget guts Medicaid; would devastate services to children and others in need

When the U.S. House passed the American Health Care Act (AHCA) earlier this month, GOP lawmakers made it painfully clear that they intended to cut and dismantle Medicaid as we know it. Cuts to Medicaid as proposed by the AHCA would shift more than $6 billion dollars onto North Carolina state government as the proposal dismantles Medicaid’s current funding structure and devolves it to a “per capita” cap or block grant. Such massive cuts would put the lives of two million North Carolinians at risk, most of whom are children. Nationally, the AHCA would cut federal funding by 25 percent over 10 years and end coverage to 14 million people across the U.S.

Now, if that isn’t bad enough, Trump’s newly released budget proposes to dramatically expand those damaging cuts. Indeed, Trump’s budget would cut Medicaid by an additional $610 billion. Together, Trump’s budget and the AHCA would cut Medicaid in half (or by $1.4 trillion). Elizabeth G. Taylor of the National Health Law Program put it this way:

“In times of great economic inequalities, the president’s budget is wildly out-of-touch, cynical and cold-hearted. Medicaid, regardless of political rhetoric, is a popular and effective health care program for low-income individuals and families and provides quality care to more than 30 million children. The program is integral to health care providers, professionals and hospitals who provide care to Medicaid beneficiaries. These cuts, if enacted, would harm tens of millions of people, and to what end?  Shrinking the federal government is not a sufficient justification when millions will suffer.”

Needless to say, such massive cuts will have devastating impacts on North Carolina’s Medicaid program. Drops in federal funding for Medicaid will force North Carolina to make difficult/impossible decisions. To maintain coverage for the state’s most vulnerable (children, people with disabilities, and older adults) North Carolina will have to raise taxes or make draconian cuts — to provider payments, benefits,  enrollment or all of the above.

To make matters even worse, Trump’s budget also goes after a program that has long enjoyed bipartisan support, the Children’s Health Insurance Program (CHIP), as it cuts approximately $6 billion from that program. On top of that, it only assumes that CHIP exists at all through 2019. Together, the proposed cuts to Medicaid and CHIP threaten the well-being and healthy development of North Carolina’s children. More than one million children rely on Medicaid and CHIP. These programs help North Carolina’s most vulnerable children – these are children in foster care, living in poverty, and children with disabilities.

Trump’s budget claims to put taxpayers first, but, this is a disastrously shortsighted claim. The truth, of course, is that children with Medicaid coverage have higher education attainment, get better jobs and are much more likely to grow up to be successful tax-paying adults. Tragically, this obvious and simple connection appears to be too much for the President and his allies in Congress to grasp.

Commentary

North Carolina’s Medicaid reform is missing one transformative component

Dr. Mandy Cohen, Secretary of North Carolina’s Department of Health and Human Services, hosted the fourth and last Medicaid Reform Public hearing last night in Raleigh. Secretary Cohen noted that even though there were hearings last year before the previous administration submitted its plan to move North Carolina’s Medicaid program to a hybrid managed care model, she wanted to hear from providers, Medicaid enrollees, advocates and community members. And like last year’s hearings, approximately half of the comments highlighted the fact that Medicaid reform is not going far enough because the state has not closed the coverage gap.

Mothers, stroke survivors, pediatricians, representatives of health insurers, and members of the faith community all called for North Carolina to extend Medicaid coverage to 500,000 North Carolinians in the coverage gap. Thirty-two states – including Washington D.C. – have successfully extended coverage to veterans, low-wage workers, students, and parents.

One health concern that was raised many times in relation to closing the coverage gap is addressing North Carolina’s opioid crisis. If lawmakers lift the Medicaid blockade, 20 percent of uninsured adults with opioid addiction can finally access the care they need. On top of that, research shows that there are at least 144,000 uninsured North Carolinians with substance use disorders or mental illness that would benefit in lawmakers extend Medicaid coverage. Research also shows that Medicaid coverage increases one’s ability to access both inpatient and outpatient treatment. For example, 37 percent of people with Medicaid coverage are able to receive treatment for opioid addiction compared to only 20 percent of the uninsured.

One of the most sobering comments came from a representative from Coastal Children’s Services. The Wilmington area is one of the the state’s hardest hit for opioid abuse and this has impacted the care at Coastal Children’s Services as between 15 and 20 percent of babies in the NICU are experiencing opioid withdrawal. Stories like this further reinforce comments along the line of one of the more pointed and succinct ones uttered last evening: “Obviously we need to expand Medicaid. Everyone knows that except for ten people in legislature.”