Commentary, Trump Administration

Comments due Monday on Trump’s scheme to bring back health plan bars to pre-existing conditions

While last year’s legislative repeal-and-replace proposals were rejected resoundingly by the American public and by a slim majority in the Senate, the Trump administration has been moving on its own to implement changes to the current health care landscape. The latest proposal from the administration would enable insurers to sell “short-term” health insurance policies that last up to 364 days—hardly a short term under any reasonable interpretation when traditional health insurance policies last 365 days. While these plans are currently on the market, they can last no more than three months under rules put in place by the Obama administration.

The Trump administration touts these plans as a solution to the country’s high health care costs. But these plans have cheap premiums because they can cherry pick whom they will cover. Upon closer examination, these plans look an awful lot like those that left millions uninsured and drowned others in medical debt before the passage of the Affordable Care Act. Here are some excerpts from a policy currently sold here in North Carolina by Golden Rule Insurance Company, which is a UnitedHealthcare company:

Preexisting conditions, and complications resulting from a preexisting condition, will not be covered under the policy.

Preexisting condition means those conditions for which medical advice, diagnosis, care or treatment was received or recommended, or a condition that had manifested itself, within the one-year period immediately preceding the effective date of a person’s coverage; or a pregnancy existing on the effective date of coverage.

Another reason that premiums are low for these plans is that you get what you pay for. These policies cover so few benefits and pay out so little in claims that insurance companies selling them actually reap much greater profits than on traditional plans. Short term plans routinely exclude benefits not just for coverage of pre-existing conditions, but also for essential services like prescription drugs, mental health and substance use disorder treatment, pregnancy care, and preventive care, among a host of others.

Even for the few services that are covered, enrollees will be stuck with large out-of-pocket bills. Some Golden Rule policies on the market have deductibles of up to $12,500 for a policy that lasts only three months, and some of these policies also impose dollar limits on what they’ll pay out in benefits over an enrollee’s lifetime or policy period. One Golden Rule policy in NC includes a $250,000 lifetime limit.

And that’s the trend: insurers make bank off of these policies while enrollees attracted by the low premium find themselves without adequate coverage and face-to-face with crushing medical debt once they need care.

These plans are dangerous to those who enroll in them. But they also undermine the ACA and those who benefit from comprehensive coverage there. Through their discriminatory premiums and benefit designs, short-term plans are designed to pull young and healthy folks out of the ACA coverage market, leaving the remaining risk pool older, sicker, and more expensive. This puts comprehensive coverage out of reach, especially for North Carolinians who make too much to qualify for premium subsidies under the law.

Unlike last year when the GOP-controlled Congress failed to revive these discriminatory plans through legislation, the Trump administration is proposing to do this through administrative rulemaking, meaning that members of the public can weigh in by submitting comments until the deadline on Monday, April 23. Click here to submit your own comment.

Commentary

Pardon me if I don’t celebrate Dale Folwell kicking 600 people off the state health plan

Dale Folwell

State Treasurer Dale Folwell  — who previously made denying people unemployment insurance benefits a top priority during his destructive tenure at the state’s Division of Employment Security — got himself the thing so many right-wing politicians always seems to covet most last week: a blaring, front page headline in which they get “credit” for cutting some poor souls off from some public benefit program. As some readers may have noticed, the N&O’s print edition on Friday featured a front page, above-the-fold story by reporter Will Doran detailing Folwell’s action to kick 601 people off the state health plan, whom he claims were ineligible.

The story says this is all the result of an audit the Folwell helped to launch when he took office last year and that it could, at least in theory, save the state around $3 million — assuming (and it’s a rather big assumption) all those kicked off really are ineligible and that they would have stayed on the program for a full year without being detected or leaving on their own.

The story also says that Folwell has slapped a new $25 per month charge on a plan that used to be free — which it describes as a “cost saving measure.”

Pardon me for not celebrating. Sure, it’s always good for public officials to make sure public benefits they help administer are only flowing to those who are entitled to them. That ought to be a basic, boiler plate duty for any government official in such a role.

That said, such things also need to be kept in perspective. Yes, we should keep public programs from being nickeled and dimed by ineligible individuals, but if anyone thinks that’s where the real money is when it comes to government waste, fraud and abuse, I’ve got some concrete I’d like to sell you for a new DOT highway. The General Assembly wastes $3 million on do-nothing special sessions and giveaways to fat cat special interests with connections to Tim Moore and Phil Berger practically every time it’s in Raleigh. And none of that spending involves providing people access to healthcare.

And that latter fact serves to highlight the broader and even more important point about Folwell’s “accomplishment” — namely the absurdity of a health care system that turns access to what ought to be a fundamental human right into an enormously confusing game of cat and mouse in which average citizens (and even public employees) must constantly negotiate a web of ever-changing rules and regulations.

The bottom line: Folwell could save the state of North Carolina a helluva lot more money and, more importantly, save a lot of human lives, if he would devote his energies to helping convince his fellow conservatives to expand Medicaid under the Affordable Care Act and building a health care system for all. That’s the kind of accomplishment that would truly be worthy of a self-promoting P.R. campaign.

Commentary

Editorial: State school takeover turns “slimy”

In case you missed it, be sure to check out an editorial that ran in the Charlotte Observer this weekend on the latest developments with North Carolina’s so-called “Innovative School District.” As Policy Watch readers will recall, the ISD is yet another school privatization scheme from legislative conservatives that calls for private operators to take over troubled schools. As readers will also recall, however, the plan has been nothing short of a disaster since its inception and has thus far managed to effect the takeover of only a single school by a single, unqualified contractor.

This is from the Observer editorial “Charlotte company behind a promising schools idea that’s become an embarrassment” that describes the developments around the planned takeover as “slimy”:

“ISD officials have struggled to find a qualified company to operate the one school initially chosen for takeover — Southside Ashpole Elementary in Robeson County. The operator that’s finally gotten the nod — Charlotte-based Achievement for All Children (AAC) — looks bad in every important way. AAC is only a year old and doesn’t have the long history of success that ISD’s creators had envisioned. Neither does a company that AAC chose as an operating partner, TeamCFA, which has a mixed record of student achievement in 13 N.C. Charter schools. That deficiency appears to violate the 2016 law that requires the operator or its partners to have a record of improving persistently low-performing schools and students.

An ISD-commissioned evaluator, SchoolWorks, also found that AAC was deficient in seven of 11 operational criteria, including startup planning, goals and “mission and vision.” In addition, SchoolWorks was alarmingly skeptical about AAC’s funding model.

But that may not be the worst part. AAC’s operating partner, TeamCFA, was founded by Oregon’s John Bryan, who contributed generously to N.C. political campaigns and has taken credit for getting the ISD law passed. On AAC’s board is Rob Bryan, the law’s author.

At the least, it’s horrible optics. At worst, it appears that North Carolina may have been scammed.

The state school board approved AAC in a somewhat contentious 7-4 vote this month, but as part of that approval, AAC must submit a response to SchoolWorks’ concerns. ISD superintendent Eric Hall told the Observer editorial board Friday he expected that response by day’s end. Hall said he’ll review it and report to the state school board. He stressed that the ISD has “significant accountability” in place.

Hall and the board should demonstrate that. Hiring AAC is, simply, an embarrassment, and any school board member voting to move forward with the company is doing a disservice not only to the students of Southside Ashpole, but to the Innovative School District overall.”

Commentary, News

The week’s Top Five on NC Policy Watch

#1 Governor appoints Joe John as head of Courts Commission after Duane Hall resigns

Rep. Duane Hall (D-Wake) quietly resigned as head of the North Carolina Courts Commission a month ago, shortly after NC Policy Watch detailed sexual harassment allegations against him.

Gov. Roy Cooper this week appointed Rep. Joe John (D-Wake) to take his place.
John said in a phone interview this week that he was honored by the Governor’s appointment. He is a first-term representative but had a 25-plus year career within the court system — he’s been a prosecutor, defense lawyer, district court judge, chief district court judge, superior court judge and court of appeals judge.

“I pretty well covered the waterfront and I have broad experience and overview as to how the court system operates,” John said. “I’m probably as familiar as anyone with the things that courts do well and the areas where probably there could be some improvement.”

The Commission, which has around 30 members, is tasked with evaluating changes to the state’s court system and making recommendations to the General Assembly.
The state court workload is one thing John hopes to address during his tenure. [Read more…]

Bonus reads in Courts & Law:
Judges: Wake legislative districts likely unconstitutional but election already underway
Pioneering women celebrate progress in the judiciary, make the case for more at Supreme Court ceremony

# 2 A second natural gas pipeline proposed for NC would run through Rockingham, Alamance counties | Read more

Bonus read in Environment:
DEQ, Duke agree on (small) penalty for illegal leaks from coal ash basins

#3 Controversial former charter principal’s involvement raises more concerns about takeover of Robeson County school | Read more

Bonus read in Education:
N.C. Supreme Court to hear arguments in pivotal Halifax County school case Monday

#4 Really? This is the best they can come up with?
After decades of propaganda and promises, the effort to privatize public schools in NC continues to fizzle | Read more

#5 Experts: We already know how to reform the state’s flawed cash bail system | Read more

Commentary

Editorial: Tillis must come clean about foreign involvement in his campaign

Sen. Thom Tillis

Dallas Woodhouse

There’s a fine editorial in this morning’s Greensboro News & Record entitled “Senator Tillis did one really good thing but needs to do one more.” In it, the N&R acknowledges that Tillis is to be commended for co-sponsoring bipartisan legislation to protect special counsel Robert Mueller from any efforts by Donald Trump to fire him. It would be better if he actually got the legislation moving, but it’s still good that he at least lent his name to it.

As the editorial also goes on to point out, however, the action to protect Mueller doesn’t insulate Tillis from the necessity that he come clean with respect to his campaign’s actions in 2014 in employing a foreign firm (Cambridge Analytica) with Russian connections. As the editorial points out, this fact was highlighted by Tillis’ hypocritical posturing in questioning Facebook CEO Mark Zuckerberg this week:

“In 2014 N.C. GOP Chairman Dallas Woodhouse hired Cambridge Analytica to help stimulate voters to support Tillis in his race against incumbent Democrat Kay Hagan of Greensboro, whom he beat in a mild upset. Until last month, when its connection to Facebook was uncovered, Cambridge Analytica’s support for Tillis was either obfuscated or overlooked.

The firm has been accused of collecting and employing the data illegally and for deploying foreign nationals to work on various campaigns, which violates election law….

Tillis has said very little about his relationship to the firm. He told the Post that it would be ‘deeply disturbing’ if his campaign was misled by a vendor. Woodhouse disclosed a $150,000 payment for ‘get-out-the-vote efforts.’ ‘No foreign workers worked for us,’ he told the Post.

But a few days later, WRAL.com quoted Cambridge Analytica whistleblower Christopher Wylie as saying the firm had ‘three or four’ full-time staffers, none of them U.S. citizens, in the state for the successful 2014 effort to elect U.S. Sen. Thom Tillis.’ New questions, still fewer answers. Every written statement from Tillis focuses on the possibility of “vendor problems.”

Tillis and Woodhouse should bring forward all records associated with the firm’s work on that campaign. What details were included in contracts and billing documents? Who were those employees who worked in North Carolina? What did they do? Bad memories and ‘vendor problems’ aren’t acceptable.

The rule of law has taken lots of bullets from Washington these past 16 months. Some of the wounds have been serious, and the damage is a long way from being contained. Tillis is admirable on one hand in its defense but to sit on a panel inquiring about a relationship for which his campaign paid and benefited is duplicitous.

Why not stand in front of the people who elected you, Sen. Tillis, and provide the sort of clear accounting you demanded from Zuckerberg?”

Click here to read the entire editorial.