Commentary, public health, Trump Administration

Another act of health care sabotage over the weekend from the Trump administration

Donald Trump speaking

President Donald Trump

On Saturday, the Trump administration announced it would temporarily suspend a program that helps health insurers in the individual market cover the costs of high-risk enrollees, injecting uncertainty into the health insurance markets that could lead to higher premiums and fewer insurers offering coverage.

Sound familiar? It should, as it’s just the latest of many Trump administration efforts to sabotage the Affordable Care Act (ACA), including a similar effort from last October when the Trump administration abruptly cut off reimbursement payments to health insurers for subsidies they provide to consumers with low incomes. That action caused North Carolinians to pay a premium hike of 14.1 percent for Blue Cross Blue Shield of NC plans this year.

The insurance industry is already sounding the alarm about this decision. America’s Health Insurance Plans (AHIP) released a statement shortly after the announcement highlighting the sabotage effect:

We are very discouraged by the new market disruption brought about by the decision to freeze risk adjustment payments. This decision comes at a critical time when insurance providers are developing premiums for 2019 and states are reviewing rates. This decision will have serious consequences for millions of consumers who get their coverage through small businesses or buy coverage on their own. It will create more market uncertainty and increase premiums for many health plans – putting a heavier burden on small businesses and consumers, and reducing coverage options. And costs for taxpayers will rise as the federal government spends more on premium subsidies.

After all, suspending the Risk Adjustment program means insurers who cover sicker enrollees are missing out on billions of dollars they are owed under the law, and if the fund transfers aren’t restored, it’s likely consumers who will pay the price.

Risk adjustment programs—which enjoy bipartisan support in programs like Medicare Part D and Medicare Advantage—exist in order to maintain a functioning health insurance market in which insurers cannot discriminate against people with pre-existing conditions. The ACA’s Risk Adjustment program requires insurance companies that enroll relatively healthier populations to transfer funds to companies who enrolled older, sicker, and higher-risk enrollees, creating a disincentive for insurers to game the system (to the extent they can under the ACA) in an effort to avoid covering high risk patients.

The administration cites a months-old U.S. District Court decision for its announcement, but legal analysts have already poked holes in the government’s case. University of Michigan law professor Nicholas Bagley writes:

CMS says that the ruling “prevents [the agency] from making further collections or payments under the risk adjustment program, including amounts for the 2017 benefit year, until the litigation is resolved.” That’s wrong. The truth is that the Trump administration has lots of options. It’s just choosing not to exercise them.

Like in other issue arenas, the Trump administration has manufactured a crisis that will harm North Carolinians, and in a continued demonstration of bad faith, it’s refusing to govern effectively.

News, public health

North Carolina advocates, health care leaders press again for Medicaid expansion

N.C. DHHS Secretary Mandy Cohen speaks on Medicaid expansion Tuesday in Raleigh (Photo taken by Phyllis Nunn).

Roughly five years after North Carolina lawmakers dismissed calls to join a federally-backed program that would have extended health care access to an estimated 500,000 low-income residents, advocates are making their case to take up the program again with the N.C. General Assembly.

“All of that uncertainty about the Affordable Care Act (ACA) is past us,” N.C. Department of Health and Human Services Secretary Mandy Cohen told supporters Tuesday, as they prepared to converge on the state legislature to press for Medicaid expansion.

“In fact, we’ve never seen more support from the Republican side of the aisle for the Medicaid program,” Cohen added.

Constitutional amendments are expected to dominate the legislative discourse during the final days of the short session, but Tuesday’s advocacy day centered on North Carolina’s myriad health care woes, and Republican legislators’ refusal to opt into the ACA’s Medicaid expansion.

GOP critics worry the expansion, which would require the state to foot the bill for 10 percent of costs, comes laden with unpredictability, despite arguments to the contrary.

Indeed, a report this year from a Wake Forest University law professor and health care expert detailed emerging evidence that costs in the 34 states that bought into Medicaid expansion have not been so erratic after all.

Backers like Cohen—an ex-federal government healthcare administrator under former President Obama who was named to the state DHHS post last year by Gov. Roy Cooper—rebuffed GOP arguments again Tuesday.

“In North Carolina, (Medicaid) has been under budget for seven years now,” said Cohen. “No one can say ‘the program’s out of control, there’s no predictability in their budget.’ Nope.”

Cohen said Tuesday that Medicaid expansion would help to close the gap for poor North Carolinians who make too much to qualify for the government health insurance program.

Cohen also estimated that the program would create more than 40,000 new jobs in the state and generate billions of dollars in new economic activity.

She pointed to other Republican-led states like Indiana, Ohio and Michigan that saw similar results after agreeing to expand Medicaid.

“This does not have to be a political issue,” Cohen said. “This is just about common sense and being pragmatic.”

Tuesday’s advocacy day was also expected to include meetings with state lawmakers, an afternoon press conference and more. It was organized by a coalition of health care advocacy nonprofits, including the progressive N.C. Justice Center’s Health Advocacy Project. [Disclosure: The Justice Center is the parent nonprofit for Policy Watch.]

Meanwhile, Cohen huddled Tuesday with two North Carolinians who say the state’s refusal to expand the health care program cut them off from vital care and medicine.

N.C. DHHS Secretary Mandy Cohen (right) speaks to Burlington resident Marta Concepcion Tuesday about Medicaid expansion. (Photo taken by Billy Ball)

“It’s just really hard that I have to be in pain and I can’t get no help,” said Marta Concepcion, a Burlington resident who said she lost her government health care assistance when she moved from New York to North Carolina in recent years.

Concepcion said she’s been diagnosed with a heart condition, sleep apnea, high blood pressure, depression and bipolar disorder, but she can’t afford medication or regular visits with a doctor.

Concepcion tearfully recalled one recent doctor’s visit where she was told that she needed a more thorough examination by medical professionals.

“She goes to me, ‘you need to get checked, because we see something wrong with you, but it’s going to cost $100.’ Well, lady, you might as well say that I came here to die, because I don’t have that money.”

Read more

Environment, public health

BREAKING: DHHS investigating suspected cancer cluster near Lake Norman

Zip Code 28117, one of two areas that have reported statistically higher than average incidences of thyroid cancer.

This is a developing story. Policy Watch will run a full story, including interviews with scientists and community residents tomorrow.

Two areas near Lake Norman have reported statistically higher than expected incidences of thyroid cancer, according to a May 29 letter obtained Tuesday by Policy Watch from the state Department of Health and Human Services.

Most of the cases occurred in two Zip Codes: 28115 and 28117.  The state undertook the analysis because of community reports of thyroid cancer, including several cases involving teenage girls.

Thyroid cancer is unusual in young people. It more commonly affects women in their 40s and 50s.

In preparing the assessment, the state’s Central Cancer Registry and the Division of Public Health concluded that from 1995 to 2016 the observed number of thyroid cancer cases in the 28115 Zip Code was two times the expected number.

In the 28117 Zip Code, the observed number was more than double over the same time period, and three times higher from 2012 to 2016.

Overall, Iredell County reported statistically higher rates of thyroid cancer: 1.5 times from 1995 to 2016, and more recently, 1.7 times from 2012 to 2016.

Zip Code 28115

“This investigation cannot be used to determine the cause of the observed cancers or identify possible associations with any risk factors,” the letter read. “It is important to note that the data and statistical analysis conducted at this step cannot determine if cancers observed in the community are associated with specific environmental, lifestyle, or other risk factors.”

Genetics and/or environmental exposure can increase a person’s risk for thyroid cancer. Exposure to radiation, flame retardants and perfluorinated compounds, such as GenX and PFOAs, can also enhance the risk. These compounds have been found in the Cape Fear River, a result of discharges and emissions from the Chemours plant near Fayetteville.

However, they also been detected at low levels in Lake Michie, in northern Durham County; since no industry discharges into the lake, Durham water officials believe the compounds are entering the water from the air.

Duke Energy built Lake Norman in the late 1950s and early 1960s. The utility’s McGuire nuclear power plant sits on the southern end of the lake; the Marshall Steam Station, a coal-fired power plant is also located on the lake, directly west of Mooresville.

The Occupational and Environmental Epidemiology Branch will review the data and determine the next steps, which will include reviewing the literature for environmental exposures associated with thyroid cancer risk, a DHHS spokeswoman told Policy Watch. “These steps will be completed with input from the community and others who have been involved in bringing attention to this issue. Information gathered will help inform whether a study can be done to look for a common exposure or risk factor among thyroid cancer cases in this area of North Carolina.”

SIR stands for Standardized Incident Ratio; CI is short for Confidence Interval. Source: DHHS

 

Thyroid Cancer Letter by Lisa Sorg on Scribd

agriculture, Courts & the Law, Defending Democracy, Education, Legislature, News, public health

The week’s Top Five on Policy Watch

1. A moment of extreme danger for NC public schools

There have been a lot of regressive education policies that have emanated from the North Carolina General Assembly in recent decades. Even prior to the Republican takeover that commenced in 2011, many Democratic leaders had already embraced the flawed conservative idea that our schools and students were struggling in many places because they were too “soft” and lacked sufficient “competition.” Hence, the early-century moves to introduce charter schools, dramatically expand the number of high-stakes, standardized tests and limit so-called “social promotions.”

In the last seven-plus years of GOP rule, the relative trickle of conservative education schemes has turned into a flood. Lawmakers have slashed funding, dramatically expanded charters (including for-profit, virtual charters), introduced private school vouchers, “education savings accounts,” “performance-based pay,” and state-initiated conversions of struggling schools to charter schools, and talked openly and repeatedly of privatizing what has long been understood to be a core function of government.

As unhelpful as each of these developments has been, however, they may well end up paling in comparison to the new and dangerous two-part change that’s currently making its way into law during the current legislative session.

At issue is the enormously controversial and dangerous plan to fundamentally alter the way North Carolina funds public schools by allowing individual cities to get into the business of running and funding public schools. Under the plan approved by the Senate last week, four wealthy suburbs of Charlotte that are angry with the administration of the county school system would be granted authority to fund their own charter schools and give priority admission to their towns’ students.

The plan is so radical and potentially game-changing that it actually drew negative votes from five Senate Republicans last week – something that almost never happens in that intensely partisan body – and is now attracting national attention. [Read more…]

2. In surprise revision to school safety bill, Senate Republicans seek insurance overhaul that may threaten NC’s Affordable Care Act marketplace

3. State lawmakers moving suddenly and swiftly to shut down nuisance suits against industrial hog farms

4. “Piecemeal” judicial redistricting: Lawmakers pushing a trio of bills that would impact a third of state’s residents

5. Amid anti-LGBTQ violence, NC Democrats seek expansion of state hate crimes law

Education, News, public health

In surprise revision to school safety bill, Senate Republicans seek insurance overhaul that may threaten NC’s Affordable Care Act marketplace

Sen. Ralph Hise unveiled a change in law Thursday that may have major implications for the Affordable Care Act.

A bipartisan-backed proposal to help North Carolina schools recruit campus psychologists received a major makeover in a Senate committee Thursday that may destabilize the state’s Affordable Care Act (ACA) marketplace, advocates say.

Senate Republicans unveiled the new portions of House Bill 933 at a committee meeting Thursday morning, potentially clearing surprise provisions aimed purportedly at lowering the threshold for small employers to offer self-funded health plans and, perhaps most importantly, clearing less-regulated association health plans for membership organizations like the N.C. Farm Bureau.

“These people, as I move around the state, are coming to me asking whether Farm Bureau can help them,” Farm Bureau President Larry Wooten told Senate lawmakers.

The Farm Bureau provides insurance, banking, and other benefits to their members in North Carolina. They also advocate for agricultural interests at the N.C. General Assembly.

Wooten and Sen. Ralph Hise, a western North Carolina Republican who co-chairs the Senate Health Care Committee, pitched the revisions to the school safety bill as a means of expanding health insurance options for residents complaining of soaring healthcare premiums.

The revisions come with federal officials considering new rules for skimpy short-term plans and association health plans. If approved by state lawmakers, the new rules would allow groups like Farm Bureau to offer health plans exempted from state oversight and from ACA regulations that protect individuals with pre-existing conditions from being excluded or facing higher premiums.

N.C. Farm Bureau President Larry Wooten

Asked Thursday whether the new Farm Bureau plan would cover pre-existing conditions, Wooten did not answer the question directly.

“Certainly, that would have to be something that we take under consideration as we move forward with this association health plan,” Wooten told legislators.

Yet Wooten reportedly indicated in a N.C. Health News report Wednesday that the organization wouldn’t be able to offer plans without underwriting, a practice that makes it more difficult for individuals with pre-existing conditions to secure coverage.

Wooten added for lawmakers Thursday that the Farm Bureau plan “would not be for everybody.”

“Certainly we would have to look at it carefully and we would tier it so people would have the ability to participate,” he said. “Obviously, some folks may be, if you look at underwriting, some folks may still be better off in the individual market and the ACA.”

Critics say the new North Carolina proposal mirrors existing exemptions for the Farm Bureau in Tennessee, which experts have linked to one of the nation’s shakiest ACA marketplaces. 

Hise’s rewrite would also scrap a state law that sets a 26-employee bar for small employers who wish to offer self-funded health plans. The proposed version Hise put out Thursday does away with that threshold altogether, although Hise said it’s his intent to ultimately set a minimum bar of 10 employees.

Some companies suggest that such plans may allow them to limit costs, although experts note they’re a much riskier option for employees.

Democrats seemed to struggle with the health care implications Thursday, particularly given Republicans bundled the reforms with a widely-supported school psychologist recruiting effort proposed in a school safety committee this year following a deadly shooting at a Parkland, Fla., high school. The House approved the bill unanimously last month.

Lawmakers did not take a vote on the Senate committee rewrite Thursday, although Republicans said they may hold at a vote at the panel’s still unscheduled next meeting.

Wooten said that his group has been working on the plan for two years, although the details emerged in a Senate committee Thursday with little or no public notice.

Opponents say the state Senate measure coincides with a GOP push to allow for slim plans in alternative marketplaces catered to “healthy” individuals, a push that threatens to weaken the ACA marketplace and drive up costs for sick individuals.

Critics quickly pounced on the proposal Thursday. The progressive N.C. Justice Center issued a statement calling the reforms “dangerous new provisions that would endanger critical protections for North Carolinians with pre-existing conditions.”

[Disclosure: The Justice Center is the parent nonprofit of Policy Watch.]

More from the Justice Center statement:

Read more