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.”

public health, Trump Administration

Trump budget weakens NC’s ability to respond to public health, workforce needs

President Trump and the GOP want to dismantle the Affordable Care Act and restructure Medicaid, and “American First: A Budget Blueprint to Make America Great Again” provides further evidence that they do not want to invest in a healthy and thriving North Carolina. While many North Carolinians may not feel the impact of the provisions outlined in the budget immediately, there are significant threats to public health, our state’s ability to address their health, and capacity to strengthen our healthcare workforce.

In addition to an 18 percent cut to the U.S. Department of Health and Human Services (HHS), the Trump budget outlines a $5.8 billion cut to the National Institutes of Health (NIH), a 31 percent cut to the Environmental Protection Agency (EPA), and the only mention of the Centers for Disease Control and Prevention (CDC) is in reference to a $500 million block grant to states. These cuts are threats to North Carolina’s public health because the NIH funds research that could help identify innovative cancer treatment, the EPA helps to ensure that rural communities have access to safe drinking water (Note: 80 of North Carolina’s 100 counties are rural), and cuts to the CDC could impact vaccine development for the next epidemic. Read more

Commentary, Trump Administration

U.S. House vote on ACA repeal and Medicaid matters to me

The first brief in the Medicaid Matters series aims to raise awareness and understanding as to why Medicaid is important not only to nearly 75 million Medicaid beneficiaries across the U.S., but to all North Carolinians. While I am passionate about the work I do as part of the Health Advocacy Project, there is a very personal reason why today’s U.S. House vote on proposals to restructure Medicaid as written in the American Health Care Act and the manager’s amendment worries me.

Like many others in my age range, I have reached the stage of life where I have taken on more responsibility for the health and well-being of my parents. My father was diagnosed with early onset Alzheimer’s disease over ten years ago. The early stages of the disease were challenging, but my family and I developed techniques to calm his fears as he realized that his memory was slipping away from him. My mother retired early to become his full-time caregiver, but recently my father’s Alzheimer’s has progressed to a more advanced stage, and caring for him at home took a toll on her health as well. My father now requires full-time supervision in a locked memory unit at a nursing home. The severity of his condition and health care needs are why restructuring Medicaid into a block grant or “per capita cap affects me.

In the U.S. and North Carolina, three out of every five nursing home residents receive the care they need because they have Medicaid coverage. My father is termed a dual eligible – as a person over 65 years old, he has Medicare, which covers his primary, acute, and post-acute care, but because he needs long-term nursing care, he also has coverage under Medicaid because nursing home services are not covered by Medicare. My father wasn’t always a dual eligible, but after months of paying for expensive nursing home care out-of-pocket, my parents’ savings that was intended for fun retirement activities dwindled to zero as his health care needs increased.

If Congress fails to block the American Health Care Act and Medicaid is restructured into a block grant or per capita cap, my father’s health is at risk. The Congressional Budget Office’s evaluation of the GOP proposal to repeal the ACA and restructure Medicaid shows that funding from the federal government for Medicaid would be cut by $880 billion by 2026. If that dollar amount isn’t shocking enough, the cuts in funding would lead to 14 million people being cut off Medicaid. Advocates and researchers have noted that if funding for state Medicaid programs is cut by either a block grant or per capita cap proposal, states will have three options to reduce Medicaid costs  – 1) cut Medicaid services, 2) cut Medicaid enrollment, or 3) cut payments to providers.

How will states like North Carolina respond to these deep and devastating cuts in federal funding? Will they make reductions to coverage for nursing home care and long-term care services? Will cuts be made to older adult enrollment? Or will states lower payments to providers to the point that they will not be able to cover the costs associated with providing care to the most vulnerable patients? These cuts put my father’s and millions of other American’s health at risk who depend on nursing home and long-term care. My father spent his life serving others — as a veteran, a police officer, and a church volunteer. He enjoyed public service and did not expect to be diagnosed with Alzheimer’s disease right after he retired. As a man who worked all of his life, served his country, his community, and provided for his family, I ask Congress to recognize that he, and millions of other Americans like him, deserve to continue receiving necessary health care services under Medicaid.  That’s why I’m hoping that Congress votes “No,” and protects the care of millions of Medicaid beneficiaries.