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

NC Budget and Tax Center, public health

Virginia votes to expand Medicaid for some. We can do better.

Last week, North Carolina’s northern neighbor, Virginia, voted to expand Medicaid coverage to 400,000 low-income residents, making it the 34th state to do so since the passage of the Affordable Care Act in 2010. If North Carolina wants to compete with our southern neighbors, as we so often hear in policy debates, now is the time for policymakers to move ahead with closing our state’s coverage gap.

They should do so for everyone, demonstrating their leadership by passing a more comprehensive coverage plan that doesn’t include red tape or exclusions.

Virginia’s state legislature voted to extend coverage to many uninsured Virginians. However, the inclusion of requirements that those eligible work a minimum number of hours each month will limit coverage for an estimated 50,000 individuals who would otherwise be eligible for coverage. It is a move that doesn’t acknowledge current labor market realities and is likely to cost the state more to implement. So-called “work requirements” create significant administrative burden for states, and will cost Virginia approximately $1.2 million in the next two years alone.

Furthermore, work requirements do not address the root causes of poverty, and they generally exacerbate the problem. Data show that almost all adult Medicaid recipients who do not work either have a disability, serve as a caretaker to family, attend school, are retired, or could not find work. These requirements hurt most enrollees, including the most vulnerable, such as children, adults with disabilities and those with substance use disorders, as enrollees wrestle with complex administrative requirements for reporting and documenting their work hours each month.

Let Virginia’s restricted expansion of health coverage be a signal for North Carolina lawmakers to enact better, evidence-based legislation that demonstrates their commitment to promote the health and well-being of all in our state.

Suzy Khachaturyan is an MSW/MPH intern with the Budget & Tax Center, a project of the North Carolina Justice Center. 

NC Budget and Tax Center, public health

This health program transforms children’s lives — so why aren’t more in NC using it?

If you are a parent or guardian of a child who receives North Carolina Health Check, or you provide medical services to children with NC Health Check, chances are you have interacted with EPSDT. The Early and Periodic Screening, Diagnostic, and Treatment (EPSDT, for short) is a mandated guideline that works to ensure children receive the care they need when they need it.

EPSDT requires states to cover a broad array of medically necessary and rehabilitative services for children under the age of 21.

Successful implementation of EPSDT is a component of a robust preventative care model that recognizes how to address child health priorities and social determinants of health. However, parents and caregivers, as well as medical providers need more information about how to take full advantage of EPSDT.

Unfortunately, this lack of information translates into low utilization rates. In 2016, only 57 percent of children eligible for EPSDT in North Carolina received at least one initial or periodic screening. What’s more, utilization of EPSDT greatly decreases as children age. By the time children reach adolescence (ages 15-20 years), less than one-third of eligible children are receiving some kind of EPSDT related screening.

A recent report from the Budget and Tax Center and the Health Advocacy Project provides an overview of North Carolina’s EPSDT program and examines the effectiveness of the program as it relates to identified child health priorities and social determinants of health. By highlighting best practices at both the state and national level, the report offers practice and policy models for how EPSDT delivery can be improved or modified to address social determinants of health and ultimately improve child health outcomes.

North Carolina has several child health priorities including asthma, physical activity and nutrition, and depression, anxiety, and toxic stress. These health priorities are discussed within the context social determinants of health such as housing, neighborhood characteristics, and adverse childhood experiences. When used correctly, EPSDT is well-equipped to manage and improve child health and well being. EPSDT also allows for community-based treatment and care coordination, which greatly improves continuity of care and health literacy.

Currently, EPSDT delivery can be improved so that a higher level of preventative care is delivered to North Carolina Children. Looking forward, North Carolina faces a unique opportunity with plans to transform health care and social service delivery. State leadership is working to transition North Carolina’s Medicaid system to a Managed Care model. This allows for an opportunity to establish a health care delivery process that is preventative, cost-effective, and patient- and community-centered. Furthermore, North Carolina’s Section 1115 Waiver Application includes language to address social determinants of health such as housing, transportation, food insecurity, and toxic stress.

Read the full report here.

 

public health

Lunch & Listen: What’s next for Medicaid and the Affordable Care Act and why Republicans are not done with repeal (Audio)

If you missed it over the weekend, be sure to listen to our interview with Dr. Jonathan Oberlander, professor of health policy and management at UNC’s Gillings School of Global Public Health and professor and chair of social medicine at UNC’s medical school.

Oberlander discussed what we can expect next for Medicaid and the Affordable Care Act after the latest failure by the GOP to repeal and replace the ACA.

“There is a bipartisan direction out there. [But] I think there is a fair chance that Republicans will try to revive “repeal and replace” and perhaps wait and see what the results are of the 2018 elections are and if they pick up seats in the Senate.”

Click below to hear his full radio interview with NC Policy Watch’s Chris Fitzsimon:

Environment, public health

Update: DEQ Sec’y Regan says “all legal options” could be used on Chemours

DEQ Secretary Michael Regan (Photo: DEQ)

NCPW reported on the EPA findings earlier today. Read the story and check back for updates.

During a media call today, NC Department of Environmental Quality Secretary Michael Regan said the state could subpoena Chemours’s company health and scientific studies on the unregulated compounds it’s discharging into the Cape Fear River.

While that data is proprietary and most likely could not be publicly released without a court order, the information could better equip state environmental and health officials to evaluate possible health effects from exposure to emerging chemicals.

Department of Health and Human Services Secretary Mandy Cohen said there are no publicly available scientific studies on these newly discovered perfluorochlorinated compounds, including two known as Nafion byproducts. Without that information, the DHHS toxicologist cannot determine a health goal or standard for them. Absent that information, Cohen said, her department’s recommendation stands: The water is safe to drink.

DHHS Secretary Mandy Cohen (Photo: DHHS)

The call was arranged after DEQ and the DHHS announced today that the EPA had analyzed state samples and found that additional and undisclosed chemicals had been found at the Chemours discharge points and in the drinking water at Wilmington’s Sweeney plant. Concentrations of two of those chemicals, known as Nafion byproducts, have not decreased, even while levels of GenX and three other previously unknown compounds have.

House Republicans accused DEQ and the Cooper administration of withholding important information about the new findings. However, Cohen said the EPA “briefed” state officials via a PowerPoint presentation on Monday, but the final report was not received from the federal government until this morning.

Regan said DEQ staff is methodically combing through the 50,000 pages of information that Chemours provided this week as part of the department’s demand for information. After that review is complete, DEQ will know better if a violation has occurred, Regan said. That review will also inform the department’s decision about whether to renew Chemours’s discharge permit, and if so, what restrictions to place on the company. Regan reiterated that if the permit is renewed, Chemours will not be allowed to discharge GenX and any other emerging compounds or contaminants of concern.

DEQ sent a letter to Chemours demanding it immediately provide additional information about the latest findings. Regan said Chemours acknowledged the correspondence and that the company said it would do so “ASAP.”