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Many people were surprised to see a story in the News & Observer today where Insurance Commissioner Wayne Goodwin seems to be giving support to opponents of the Affordable Care Act. The article is about a letter that Goodwin sent to federal Health & Human Services Secretary Sylvia Burwell about problems in the North Carolina insurance market.

To understand the letter context is important. Commissioner Goodwin previously raised concerns about implementation of the federal Affordable Care Act with Sec. Burwell at a national meeting and she asked that he put all of his worries about the insurance market into a letter. This is not Goodwin’s broad thoughts on health reform. Instead it’s addressing immediate problems he sees for the stability of insurance companies and agents.

Another critical bit of context is that many of the stumbling blocks cited in the letter are the result of North Carolina not fully implementing the Affordable Care Act. By not establishing a state exchange and by declining to expand Medicaid, Commissioner Goodwin is left helping to steer a half-built car. Not surprisingly, we are hitting bumps. It’s understandable that while he is getting jostled the Commissioner is focused on the potholes. Insurance companies are upset that they are getting some unhealthy customers. Insurance agents and brokers are upset that insurance companies are limiting commissions. Consumers, especially those who don’t qualify for subsidies, are upset about rising premiums. All sides are demanding action from Goodwin but the state outsourced his authority to Washington, DC. That’s why he wrote the feds.

Having said all that, his letter is still perplexing. Perhaps he felt an alarmist tone was warranted because he wanted to get Washington’s attention. He notes, for example, that fewer insurance companies are offering plans now than before implementation of the Affordable Care Act. True enough, but many of those insurance companies weren’t even actively selling plans and had nearly nonexistent enrollment numbers. Blue Cross Blue Shield of NC wrote almost all of the individual insurance policies before the ACA. Now BCBSNC has seen it’s market share diminish as other companies offer meaningful competition.

It’s also true that BCBSNC reported a financial loss last year as medical claims increased by $1.4 billion from the prior year. But revenue at the company also increased $1.6 billion. Losses in Medicare Advantage plans and taxes produced a net loss for the company. It was, by the way, the company’s first year in the red in more than a decade. By their own admission this wasn’t surprising given the market uncertainty right now. That’s why BCBSNC maintains a comfortable reserve. Not many industries can claim such a unbroken stretch of profitability.

Also, North Carolina is nearing 600,000 enrollees in Affordable Care Act plans and our uninsured rate is dropping.

In sum, this letter is not the Insurance Commissioner’s considered opinion of health reform; instead it is a cry from the Commissioner that the state took his steering wheel and he could use a little help righting the car.

Commentary

A new poll from the nonpartisan organization NC Child shows that a large majority of North Carolinians support closing the health insurance coverage gap that was created when the Governor and legislature declined to use available federal funds to expand Medicaid eligibility. This support extends to Independents and Republicans. The poll found that overall 72 percent of North Carolinians support closing the coverage gap. Among the Independents who often make the difference in close elections support is 62 percent. The same percentage of Republicans want to close the gap.

You can read the analysis from NC Child here.

We know that support or opposition to closing the coverage gap can depend on how you ask the question. This poll was a pretty straightforward description of the Medicaid gap and the policy option before the Governor and legislature. Here’s how the poll was worded:

In North Carolina, more than 350,000 adults, most of them working, cannot afford health insurance on the wages they are paid in industries like retail, construction, and food service. Their incomes are too low to qualify for the tax credits available through the Affordable Care Act and too high to qualify for Medicaid. They are stuck in the ‘insurance coverage gap.’ The Legislature and Governor McCrory could fix the coverage gap by creating a special North Carolina plan in partnership with the Federal government. Do you think North Carolina should make a plan to fix the health insurance coverage gap, or not?

We’ll have to see whether this changes the minds of political leaders. After elected officials in a number of conservative states saw similar polls and watched federal funds flow to other regions they decided to take action to protect their residents and boost rural health care. Let’s hope our politicians have a similar reaction.

Commentary, News

Medicaid expansionStill more experts have weighed in in favor of following the lead of dozens of other states and expanding Medicaid in North Carolina. A new report by a pair of Wake Forest University professors of health law says that North Carolina leaders are making a mistake by refusing to act. Click here to read “Medicaid Expansion Costs in North Carolina: A Frank Discussion.”

Here’s the conclusion:

“There is no denying that Medicaid expansion in North Carolina will have some costs. And, for those who distrust the federal government with a fiery passion, there may be nothing that can convince them to consider this major expansion of federal support. However, a more dispassionate examination of the issues greatly reduces well-founded concerns over expansion costs to the state.

Several expert studies have calculated what actual expansion costs would be, and what portion of those costs the state would actually bear. Expansion funding, like an iceberg, has both a visible tip, and a much larger hidden part below the surface. The tip of expansion costs, which are several billion dollars a year, is the 10 percent that the state would have to pay. The federal government pays the rest. That much larger, 90%-hidden part of the iceberg represents not a cost to the state, but instead money coming into the state.

This new federal funding melts throughout the state’s economy. The increased federal funds would create new well-paying jobs and boost economic activities that increase tax revenue without increasing tax rates. Expansion would also create savings for the state by reducing what it has to spend both on existing Medicaid recipients, and on other non-Medicaid programs like mental and substance abuse treatments and medical care for inmates. And, federal funds reduce what state and local governments currently pay for free care that now goes to low- income people who lack insurance. All told, these economic benefits and savings to state and local governments will approximately equal the extra costs to the state of expansion.

That math works as long as the federal government does not reduce what it will pay for North Carolina residents on Medicaid. Although the ACA has survived every one of the legal and political challenges it has faced, there is no guarantee that federal support will continue forever. However, it would be both illogical and extremely difficult for the federal government to back out of its deal with the states now. Even if some risk remains, states are not defenseless; they can take several steps to protect themselves, in the form of triggers, sunsets, or waivers.

The question, then, for the people and the leaders of North Carolina, is whether a small cost and a small risk are prices worth paying to provide insurance coverage to several hundred thousand people who cannot afford coverage on their own, even though the majority of them are working.”

Commentary

Despite policymakers’ attempts to repeal all or parts of the Affordable Care Act (ACA) nearly 60 times, the ACA works. Further, both times all or certain provisions of the ACA have been to the Supreme Court, the health care law has remained mostly intact. In 2014, the ACA enhanced the well-being of nearly 460,000 North Carolinians who were able to obtain affordable health care coverage. Open Enrollment 3 started on November 1, 2015 and goes until January 31, 2016. While many residents of the Tar Heel state understand the benefits of the ACA, only 28 percent of enrollees are young adults based on 2014 enrollment data. Tomorrow, January 21st, is National Youth Enrollment Day and advocates of the ACA are encouraging young adults to get covered.

Why should young adults enroll in the ACA?

  • Even though the ACA allows youth until age 26 years to remain on their parents’ insurance, adults between the ages of 19 and 34 years are still the most likely to be uninsured.
    • Many pediatricians will continue seeing patients until they complete secondary school and college or until 18 to 21 years. For many young adults, once they leave pediatric care, they do not have a regular primary care doctor until their 30s and 40s.
  • Young adults are the least likely to have a health care home. Individuals who do not have a regular place to seek health care are more likely to rely on urgent or emergency care.
  • You can shop the Marketplace to find a coverage plan that fits your budget. This is especially important because…
    • Young adults were the hardest hit by the Great Recession, thus increasing the need for financial help in obtaining care through the ACA;
    • The average amount of financial help North Carolinians receive is $315 per month;
    • The penalty for not obtaining health care coverage has increased to $695 per person or 2.5 percent of one’s household income, whichever is higher. For more information please visit: https://www.healthcare.gov/fees/fee-for-not-being-covered/ or call: 1-855-733-3711;
    • As of November 2015, 81 percent of ACA enrollees from NC selected plans that cost less than $75 per month.
  • Health care coverage offers one peace of mind…
    • No longer have to worry about whether you can access affordable or quality care when you need it;
    • No longer have to worry about waiting until a health concern becomes severe or chronic and thus more costly;
    • No longer have to worry about bankruptcy or the financial burden from medical bills if you or a loved one gets sick.
  • Affordable health coverage helps young adults access primary care preventative care…

There are 11 days left to enroll, please visit healthcare.gov to start the enrollment process!

Commentary
Enroll America

Image: www.enrollamerica.org

Despite policymakers’ attempts to repeal all or parts of the Affordable Care Act (ACA) nearly 60 times, the ACA works. What’s more, the law is clearly here to stay. On both occasions that all or specific provisions of the ACA have been to the Supreme Court, the health care law has remained largely intact. In 2014, the ACA enhanced the well-being of nearly 460,000 North Carolinians who were able to obtain affordable health care coverage.

Now, it’s time once again for the uninsured to enroll. Open Enrollment 3 started on November 1 and goes until January 31, 2016. As of December 5, nearly 200,000 people in North Carolina had applied for health care coverage through the Marketplace. Today, December 15, is the deadline to enroll for health coverage starting on January 1, 2016.

Even though there has been much attention paid to increasing premiums for coverage purchased through the Marketplace, many North Carolinians will still receive financial help. The average amount of financial assistance received by ACA enrollees is $315 per month. Further, the majority of enrollees selected plans costing less than $75 per month.

Another fiscal consideration is that the penalty for not enrolling in a plan is increasing to $695 per person or 2.5 percent of one’s household income, whichever is higher. 2016 will also be the first year that people will not receive an additional grace period or special enrollment period around the tax deadline. Even though the financial impact of obtaining health coverage is significant for many households and individuals, having access to health care gives one peace of mind. The ACA mandates the coverage of essential health benefits ranging from maternity and newborn care to mental health and substance use disorder treatment.

Unfortunately, hundreds of thousands of North Carolinians will not qualify for health coverage through the ACA, do not have access to employer based health insurance, and are ineligible for Medicaid. Our state policymakers have failed to extend health coverage through Medicaid expansion to home health care workers, parents, office clerks, and school bus drivers.

One year ago, the Cone Health Foundation released a report highlighting the benefits of Medicaid expansion. If our state legislators would have chosen to expand Medicaid, 29,000 jobs would have been created this year. In addition to the approximately 200,000 (and counting) North Carolinians who will have health coverage starting in the new year by enrolling in the ACA, according to the report 300,000 people would have gained health coverage if policymakers had decided to expand Medicaid this year. Let’s start 2016 on a healthy note, enroll for health coverage today and encourage your state policymakers to expand Medicaid to 500,000 North Carolinians in the coverage gap.