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After reading this fact sheet from the American Public Health Association (APHA), it is apparent that NC policymakers need to take action in order to improve our state’s public health. If our state legislators were assigned a grade for how they are investing in NC’s public health, it would not be a passing grade. The following statistics show there is much room for improving NC’s public health rankings:

  • Ranks 8th for prevalence of diabetes amongst adults.
  • Ranks 47th for the availability of dentists.
  • Ranks 10th for infant mortality.
  • Ranks 47th for the amount invested in each person’s public health needs. NC spends $11.73 per year per resident.
  • Ranks 5th for the number of children living in poverty.

While these numbers are unimpressive at best, there are some public health areas that NC has improved on. First, the high school graduation rate has improved, but then again the Senate budget proposes tax cuts that lower the number of teacher assistants, which could negate the progress made. Second, NC has made great progress in reducing air pollution, but then again the House wants to cut auto emissions tests in some counties.

Even though the sequester led to significant cuts in public health funding, there is federal funding available to address the poor rankings listed above. NC could receive funding to help the following:

Fifteen percent of North Carolinians are uninsured and 500,000 people are in the Medicaid coverage gap. These are people that could seek primary preventative health care that will yield better health outcomes such as prenatal and maternity care to ensure healthy outcomes after childbirth. Research has shown that children eligible for Medicaid miss fewer school days, have higher educational attainment. and their families have more financial security. There are also 150,000 people in NC in the coverage gap with mental health and substance use disorders that need ongoing treatment. The Affordable Care Act has written into law that the federal government will cover 100% of Medicaid expansion costs until 2016 and up to 90 percent of costs starting 2020. Ensuring coverage to one half million North Carolinians is one public health act that will pull NC up the rankings.

Commentary

Editorial writers have penned several good ones across North Carolina in recent days.

This morning’s Winston-Salem Journal is on the mark when it reminds the state Senate that driver’s education should remain in the public schools. As the editorial notes: “It’s not just a matter of money, but of public safety.”

In an editorial entitled “There’s a better way than political gerrymandering,” the Fayetteville Observer says this:

“In one of its final decisions before ending its term this week, the U.S. Supreme Court upheld Arizona’s use of an independent commission to draw congressional districts.

We hope the leaders of the N.C. Senate took note. The decision gives them one less reason to resist a bipartisan initiative to create a redistricting commission here.”

An editorial in Raleigh’s N&O comments on native daughter Loretta Lynch’s return to the state yesterday by noting her sterling qualifications to be the nation’s new Attorney General and blasting the GOP Senators who filibustered her nomination:

“Disgracefully, both of North Carolina’s Republican U.S. senators, Richard Burr and Thom Tillis, opposed Lynch’s nomination on thin and blatantly partisan grounds. They embarrassed themselves more than they did Lynch, and Tillis as a freshman failed the political character test.”

The Charlotte Observer expounds thoughtfully on “Three more Supreme Court decisions that could – and should – have an impact on North Carolina.”

And, finally, in case you missed it, a Tuesday editorial in the Asheville Citizen-Times gets it right with this take on the Affordable Care Act:

“The Affordable Care Act is here to stay. It’s time for critics to stop trying to repeal it and start trying to improve it.

The Supreme Court put the final nail in the repeal-ACA coffin last week when it upheld health-care subsidies in states that have not set up their own insurance exchanges. By a 6-3 vote the justices recognized a drafting error for what it was and rejected the notion that Congress would have deliberately written a law to guarantee it would not work….

The ACA is not perfect. The unwieldy law is too complicated for many Americans and it faced an embarrassingly rocky rollout as thousands were unable to access the website. Its effect on the labor force is yet to be fully ascertained, but there’s always the threat of reduced employee hours and a smaller workforce if people don’t need a job for benefits.

We’re all up for discussing ways to improve the ACA. But the opposition is going to have to bring concrete solutions to the table to build off of the plan instead of continuing to face a fruitless battle to tear it down.”

Commentary

As Adam Linker noted yesterday in the post below, there are no more excuses now for Gov. McCrory:

“Now that the Supreme Court has ruled — again — that the structure of the Affordable Care Act is constitutional, it is time to move forward with making the law work better in our state.

The first, and most important, step is accepting federal funds to extend the benefits of affordable health insurance coverage to 500,000 more people in our state. Gov. McCrory said last year that his staff was assembling options to expand coverage and that he would make an announcement about his recommendation after the Supreme Court ruled in King v. Burwell. The ruling has arrived.”

This morning, major newspapers around the state are echoing this sentiment.

From the Durham Herald-Sun:

“With the question of the act’s validity answered by the court, it’s time for North Carolina
to reverse its unfortunate decision to not extend Medicaid coverage to an estimated
500,000 individuals and families too poor to qualify for the ACA subsidies.”

From the Greensboro News & Record:

“This was an enormous victory for President Obama. Most importantly, it avoids the human toll that would have resulted from an adverse ruling.

Next, North Carolina should expand Medicaid coverage for thousands of residents who still fall between the coverage cracks. State leaders should have expanded Medicaid in the first place, but seemed more intent on thumbing their noses at the president than doing what’s right. Not only is most of its cost paid for by the federal government, but also it would create as many as many as 43,000 jobs. Gov. Pat McCrory had said he wanted to wait for the Affordable Care decision first before considering that step. Now that the high court has ruled, it’s time for him to act.”

From Raleigh’s News & Observer:

“Meanwhile, Gov. Pat McCrory has shown a lack of political courage in declining to support an expansion of Medicaid, the state and federal insurance program for the poor and disabled. The federal government, under the Affordable Care Act, would pay 100 percent of the expense in the first three years and at least 90 percent thereafter. McCrory said he was awaiting the high court decision to make his own decision about pushing for Medicaid expansion. But he wasn’t. Once again, the 500,000 North Carolinians who could be helped are left to hope that a move to expand Medicaid comes before an illness or an accident does.”

In other words, come on Governor, get off your keister do the right thing!
Commentary

While many of us are anxiously waiting for the Supreme Court decision on King v. Burwell, a recent poll shows that 44-percent of people still don’t know much about the case.

The King v. Burwell ruling will determine the legality of health insurance subsidies for states using the federal marketplace. If the Supreme Court rules against the Affordable Care Act (ACA) and decides that health insurance subsidies for the 34 states that do not have a state marketplace are “illegal,” more than six million people across the U.S. may lose their ability to access affordable health care. Since they live in one of the states that rely on the federal marketplace, 458,738 North Carolinians could lose their health coverage. Nationally, the average subsidy (or advance tax credit) amount is $272 per month and in North Carolina, people receive $316 per month.

Considering that subsidies could become unavailable as early as September 2015 and that North Carolina has failed to expand Medicaid, the number of uninsured could increase to nearly one-million people. Sylvia Burwell, the Secretary of Health and Human Services, has stated that if there is a negative outcome from the Supreme Court decision on King v. Burwell, the U.S. Congress and state policymakers will have to decide on how to keep access to health coverage affordable.

As data continue to show that the ACA is working to increase access to care – for example, the rate of uninsured women has decreased nearly eight percent since 2013 and 12.2 million adults have access to health care in the 30 states (including DC) that have expanded Medicaid – state lawmakers and Congress may be feeling even more pressure to keep subsidies. Even the Congressional Budget Office has reported that gutting the ACA would increase the deficit by $137 billion by 2025. Despite the potential economic impact, media reports continue to highlight the fact that conservative policymakers in Washington D.C. do not have a better alternative to the ACA. Further, one “fix” proposed by Sen. Ron Johnson of Wisconsin would only extend subsidies for current ACA enrollees until 2017.

If the outcome of King v. Burwell isn’t positive, let’s hope that our state and national policymakers work to keep 6.4 million people insured. No matter how the Supreme Court rules, let’s hope that our state policymakers will take on the next challenge – extending access to affordable health care to 500,000 North Carolinians in the coverage gap as Medicaid expansion makes economic and moral sense.

Commentary

IMG_0831Last year Mayor Adam O’Neal from the tiny, scenic town of Belhaven, NC, made national headlines as he walked nearly 300 miles from Beaufort County to Washington, DC, to protest the closing of his rural hospital and to urge states to accept Medicaid expansion.

On Monday, June 1, O’Neal left Belhaven to replicate last year’s feat. And this year he is taking along advocates from around the country. As marchers filed out of town yesterday to start the arduous journey they wore shirts advertising their home states. A team of advocates travelled from Texas, some came from West Virginia and Alabama, a rural hospital CEO from Kentucky joined the walk, as did a woman from Seattle, Washington.

The message of the marchers is clear: we must save rural health care.

A key part of that agenda includes expanding Medicaid, as an Episcopal priest from Belhaven reminded the audience during a prayer before the send off. Rev. William Barber from the NC NAACP noted that Jesus made health care a central part of his ministry.

You can follow the march at this website. You can also tweet with the hashtag #savethe283. That refers to a national estimate that 283 rural hospitals are at risk of closing this year.

You can also join the final rally as marchers reach Washington, DC, and gather at the Capitol on June 15 at 10am.

And, finally, you can ask legislators and the Governor in North Carolina to accept new federal Medicaid funds to expand insurance coverage to 500,000 more people in our state.