Commentary, News

Yet another sign that Obamacare is helping the people who really need it

The Washington Post has still more encouraging news about the beneficial impact of the Affordable Care Act:

People enrolled in health plans through the Affordable Care Act exchanges are ramping up their use of prescription medications more rapidly than those in employer or government-sponsored plans, according to a new report from Express Scripts, the largest prescription drug benefits company.

In 2015, people in the exchanges increased their number of prescriptions filled by 8.6 percent, four times the rate of people who receive insurance through commercial plans outside of the exchanges. That, along with price increases, led to a 14.6 percent jump in drug spending for people in the exchanges, nearly three times faster than all drug spending. The findings are based on Express Scripts data, which includes about a third of the pharmacy claims filled by all people insured through the exchanges.

This “has impact for insurers who are going to want to manage this program, given that people who need more care are more likely to join the program,” said Glen Stettin, senior vice president and chief innovation officer at Express Scripts. “If they want to continue to have an affordable benefit, they’re going to have to manage this tightly.”

Although the growth in spending and use of prescription drugs was faster for patients in the exchanges than for those in commercial plans, the overall amount spent was much lower per person — $777.27 compared to $1060.75.

The rapid uptake of the prescription drug benefit suggests there was a significant unmet medical need for many people gaining insurance through the exchanges, some of whom could have preexisting conditions and may not have previously had access to medicines. Before 2014, insurance companies could refuse coverage or charge much higher premiums for people with preexisting conditions, a practice largely forbidden under the Affordable Care Act. An April 2014 report from Express Scripts found that people insured through the exchanges were four times more likely to have a prescription for an HIV medication than those in commercial plans.

In other words, more confirmation that more Americans are getting the care they need and that the ACA is succeeding in promoting longer, healthier lives for millions of people. Click here to read the entire article.

Commentary

Why thousands will come to Raleigh tomorrow for the HK on J Moral March

Moral March on RaleighAs was explained here earlier this week, there are lots of excellent reasons to bundle up and head to downtown Raleigh tomorrow morning. In today’s edition of Raleigh’s News & Observer, however, Charles van der Horst, a retired Professor of Medicine at UNC, highlights what may well be the single most important reason: to save thousands of lives by demanding that state leaders expand close the Medicaid gap by accepting federal dollars to expand Medicaid coverage.

Here’s Dr. van der Horst:

“On Saturday, I am rising early with other health care workers and students to carpool and bus to Raleigh, where we’ll march once again down Jones Street for some old fashioned rabble-rousing.

Since the ACA started, 31 states and DC have expanded Medicaid. Ten states led by conservative Republicans, initially vehemently opposed to Medicaid expansion, have reversed course. In three states where Republicans subsequently won governorship, they elected to continue the expansion. Two Republican-led states are in discussion to expand.

These leaders came to their senses when they realized the benefits in savings, the jobs created, the federal dollars flowing to their states instead of away, and the help to their citizens. When that many Republican governors and legislatures have expanded Medicaid, it is difficult to understand why McCrory, Senate Pro Tem Phil Berger and Speaker of the House Tim Moore have ignored the economic and health benefits to the state.”

And here is the excellent conclusion:

“With two years of data available, the health benefits of expanding Medicaid are clear. In states that did not expand Medicaid, rural hospitals have been closing as they could no longer afford to provide free care. From 2010 to 2015, 57 rural hospitals closed, 42 of them – including three in North Carolina – in states that did not expand Medicaid. Rich or poor, it is nice to have a hospital close when your heart stops beating.

Medicaid expansion also allows for more preventive medicine. The governor and legislature have adopted the concept of penny wise, pound foolish. From blood pressure control to cholesterol and diabetes care, the cost of treatment for complications far exceeds that of prevention.

In April the legislature reconvenes. They should listen to the health care workers across the state and lift the block on Medicaid expansion.”

Commentary

Context is key for understanding Insurance Commissioner’s Affordable Care Act comments

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

Independents and Republicans in NC support closing the coverage gap

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

Wake Forest researchers: NC should close the Medicaid gap now

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.”