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.

Commentary

Proposed federal Medicaid cuts, policy changes could be disastrous; General Assembly must act

Republicans in Washington are upping the ante when it comes to destroying health coverage gains that resulted from the Affordable Care Act. In addition to eliminating provisions that protect and ensure affordability to millions of Americans, the GOP has added provisions that would eliminate Medicaid expansion. Thirty-one states and DC were able to make significant coverage gains once they expanded Medicaid. Even though North Carolina’s Senate and House leaders continue to block expansion and thus leave 500,000 North Carolinians in the coverage gap, the leaked plan has provisions that will greatly impact North Carolina’s Medicaid program.

The latest plan would restructure Medicaid into either a block grant or a so-called “per capita cap” program. Conservatives claim that the aforementioned proposals will offer states more “flexibility,” but that’s really just spin designed to camouflage what’s really being proposed — slashing funding for programs that help vulnerable Americans live up to their full potential and contribute to their communities. Currently, the federal government funds 66.7 percent of Medicaid spending. In other words, for every $100 in Medicaid spending, the federal government pays $66.70 while the state funds the remaining cost. Block grants and per capita caps would reduce the federal government’s commitment to funding Medicaid.

As Medicaid is a joint federal and state program, a significant decrease in federal funding really only gives states more flexibility to make hard decisions. If Washington heads down this road, North Carolina lawmakers will have to choose which North Carolinians to cut off, which services and benefits to end and/or which provider reimbursements to “recalculate.”

North Carolina’s Medicaid program likes to boast of the high provider participation it enjoys, but that will change dramatically if the promised cuts are enacted. If states no longer get significant financial support, North Carolina will likely have to cut services. Eighty percent of Medicaid beneficiaries in North Carolina are among our state’s most vulnerable. These are children, seniors, and people with disabilities. Even with a per capita cap, there is not guarantee that that set amount each person receives for Medicaid will meet the costs for their health care needs. Even if North Carolina lawmakers want to keep coverage at current levels, trends show that per capita spending always exceeds actual economic growth.

The bottom line: State lawmakers must be prepared to act and minimize the damage if the federal government heads down this road. They must also consider how proposed changes in Congress will impact the Medicaid reform proposals that the state recently submitted. The Medicaid reform waiver states that North Carolina’s new Medicaid program will lead to: 1) Better experience of care, 2) Better health in our community, 3) Per capita cost containment and funding stability, and 4) Improved provider engagement and support. These kinds of changes won’t happen merely through wishful thinking. To maintain viable and effective Medicaid system in these difficult times, we will need our state leaders to stand up for North Carolina’s providers and the most vulnerable.

Commentary

Another byproduct of the Medicaid Blockade: Catastrophic medical bills, massive debt for families

There are a lot of terrible problems that North Carolinians have been forced to endure as a result of the Medicaid Blockade that state legislators continue to enforce. Here’s another especially awful one: Every year, an average of 14,776 North Carolina families experience financial distress as the result of catastrophic medical bills. This is the case even though 67 percent of families lacking health coverage have either a full-time or part-time worker in the family.

Happily, in spite of the Blockade, the Affordable Care Act has helped millions of people. Prior to passage of the ACA, 41 percent of adults between ages 19 and 64 years reported having trouble paying medical bills and/or accumulated medical debt. As the ACA has increased Americans’ ability to access more affordable health coverage, however, the number of people reporting difficulty paying their bills fell by 13 million people in the past five years. Unfortunately, the Blockade has prevented these benefits from flowing to hundreds of thousands of other people who need them.

Not surprisingly, there is a strong association between medical debt and lack of health care coverage. And, of course, thanks to the Medicaid Blockade, there are 500,000 North Carolinians in the coverage gap and thus at risk of facing catastrophic medical bills. What’s more, many of these insurmountable medical bills result from one-time events. Take, for example, Jacqueline and Darian. Five years ago, Darian experienced a workplace injury that has left him unable to return to the labor force. Even though Jacqueline still works, she does not have employer-sponsored health insurance. Unfortunately, both are in the coverage gap.

Darian’s workplace injury resulted in a medical bill of close to $20,000. That is a lot of money for most families and completely beyond the means of low-income working families. Luckily, Darian was among a relatively small group of people who are able to obtain charity care. But, while Jacqueline and Darian appreciate the charity care they received, they understand that their fiscal, physical, and emotional health are still at risk in the event of another accident, unforeseen injury or health emergency. What’s more, both also recognize that they are not alone in their financial fragility; they understand that medical debt and its many related impacts are a huge community-wide plague.

The bottom line: People like Jacqueline and Darian understand only too well that even hard working North Carolinians can lose their ability to work and contribute financially to their communities if they lack access to health care and remain uninsured. And thanks to the Medicaid Blockade, this is a huge problem that’s not going away any time soon.

Commentary

Middle-aged, stuck in the coverage gap and still years away from Medicare

Seventeen percent of adults stuck in the Medicaid coverage gap are between the ages of 55 and 64 years and many have worked most or all of their adult lives. What’s more, 56 percent of adults in the gap are currently working. Unfortunately, when there are economic downturns, some hard working individuals lose their jobs.

Sonya’s story reflects the stories of many older adults that have worked and paid their taxes most of their lives. Unfortunately, Sonya lost her employer-sponsored health coverage when she lost her job. Now that Sonya no longer has employer-sponsored health coverage and no longer qualifies for Medicaid because her youngest child has aged out, she has limited to access the health care she needs.

While the Affordable Care Act has helped many people gain Marketplace coverage, Sonya was unable to enroll given her financial situation. She tried to gain coverage through Social Security disability insurance as she has chronic back issues that impact the type of work she can do. Unfortunately, she was denied disability coverage. This leaves Sonya in the coverage gap. Like 500,000 other North Carolinians, Sonya does not meet the eligibility for Medicaid and cannot afford to purchase coverage on the Marketplace. She is, at once, too well-off and too poor.

Thanks to the Medicaid Blockade led by Speaker Moore and Senate President Berger, Sonya is in the coverage gap. She has over five years until she can obtain Medicare coverage. Thus, Sonya is delaying the preventive and urgent care she needs to help improve her chronic back conditions and behavioral health concerns. Like many fellow Tar Heels, Sonya is working hard to pave her own path to coverage. She saves money to see a health provider for her ongoing health concerns. She is even going back to school to become a counselor. Sonya is hoping that with higher education she will be able to get a job that will offer insurance. For now, however, likes hundreds of thousands of her fellow North Carolinians, financial ruin is just one accident or one unforeseen illness away.