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Thom_Tillis_official_portraitWhen I last posted about the Senate debate between Speaker Thom Tillis and Sen. Kay Hagan I had listened to the exchange on radio but I had not yet watched the video. Watching television coverage of the debate one could hardly miss that Tillis was, once again, wearing a blue lapel pin from the science and advocacy organization Autism Speaks.

The pin highlights an important question that the media and voters should be asking Tillis: Where does he stand on minimum coverage requirements for insurance?

The primary argument Tillis pushes against the Affordable Care Act and Sen. Hagan is that the health law set a new floor for health insurance benefits. That’s why some plans were initially cancelled. It’s why some plans cost more than before the enactment of reform. But for the Autism community setting minimum standards for insurance was one of the most important parts of the Affordable Care Act. In fact, Autism Speaks and the Autism Society are still doing critical work to ensure that insurance companies are adhering to these new mandates.

Moreover, Tillis personally advocated for a bill expanding on the minimum requirements set by the ACA by mandating insurance coverage for the diagnoses and treatment of Autism Spectrum Disorder.

Assuming that Tillis was sincere in his support of new insurance requirements it’s difficult to see how he could object to the health reform law establishing similar mandates. And if he supports minimum requirements in general but opposes specific coverage mandates in the ACA then he should specify which services he would make optional for insurance companies. Would he say that insurers can go back to not covering pregnancy? What about prescription drugs?

The answers to these questions cut to the core of the Speaker’s opposition to health reform and voters need to know where he stands.

Commentary

Health-Reform-SBIn case you missed it, be sure to check out Sahil Kapur’s article today on Talking Points Memo about the fast-fading attacks on Obamacare and why a political “nightmare” may be coming to pass for the American right. One of Kapur’s key sources: none other than long-time conservative icon William Kristol, who two decades ago led the charge to defeat Bill Clinton’s proposed healthcare overhaul. Back then, Kristol’s chief fear was of what would happen was, effectively, the same thing that is happening now: the establishment of a new law that would fast become an integral part of the middle class safety net and, as such, quickly become politically unassailable.

As the TPM story notes: the massive healthcare industry is adapting, premiums are stabilizing and even Mitch McConnell wants the hundreds of thousands of newly-insured Kentuckians to keep their Obamacare.  In short, Kristol’s fear that “reform would paint Democrats as ‘the generous protector of middle-class interests’ and strike a ‘punishing blow’ to the GOP’s anti-government ideology” appears, by an increasing number of indications, to be coming true.

Commentary

Medicaid expansionOur old NC Policy Watch colleague Adam Searing had a great post last week on the Georgetown University Health Policy Institute blog, Say Ahhh! that explains why Medicaid expansion is fast reaching the tipping point as states that once said “no” are now seeing the light. Let’s hope North Carolina come to their sense soon.

It’s getting harder and harder for Governors to say no to the great deal being offered to them through the Medicaid expansion option.  Just last week Pennsylvania reached agreement with the federal government on a Medicaid expansion waiver and news stories show possible movement in Wyoming, Utah and Tennessee.

This new momentum forward shows that more state leaders are willing to stand up to those with intransigent ideological views to find a common sense approach towards managing their state’s finances and health care system.  Three factors are driving the change:

Hard Numbers

Before January 1, 2014 – the first day states that accepted the federal Medicaid expansion could open their programs – the costs of not doing so were largely theoretical.  Now that a growing majority of states have expanded coverage, the choice on Medicaid is no longer a hazy public policy debate but one where hard numbers on the cost of not expanding coverage are now available between the states that expanded coverage and those that have not. Read More

Commentary

As expected health care played a major role in the first debate between Sen. Hagan and Speaker Tillis.

Tillis took two major lines of attack against Sen. Hagan on health care: he chastised Hagan for saying that people could keep the insurance plan they like, and he criticized the policy of setting minimum standards for insurance plans. He also mentioned at the end of the debate that people will pay 11 percent more for insurance next year but that was a strange sidebar claim with no evidence to support it. Insurance policies are not yet posted and have not even completed regulatory review.

On the first point Tillis chose his words carefully. Koch brother groups in North Carolina keep claiming that thousands of people in the state lost their insurance. The Tillis camp apparently realizes that this is a ridiculous assertion. So Tillis said that thousands of people received cancellation notices from their insurance company. This thrust was parried by Hagan when she pointed out that the plans were continued when she and other members of Congress pressured the Obama Administration to keep the policies in place. She also noted that insurers continued selling non-compliant insurance plans to consumers after the Affordable Care Act was signed without adequately explaining that the policies would have to change after 2014.

On the second point Tillis argued that people should be able to purchase any insurance plan they want without regulations on what is covered. The Affordable Care Act imposes some standards on insurance policies. Hagan didn’t spent much time responding to this charge, although she could have noted that his push for mandating that insurance cover Autism treatments directly contradicts his criticism of health reform. The problem with deregulating insurance is twofold. Read More

Commentary

Medicaid expansionIn case you missed it, be sure to check out this story in the Charlotte Observer by Ann Doss Helms and Tony Pugh about North Carolina’s ongoing and self-destructive refusal to accept federal dollars to expand Medicaid to hundreds of thousands of North Carolinians in need. As the Helms and Pugh report:

North Carolina taxpayers could spend more than $10 billion by 2022 to provide medical care for low-income residents of other states while getting nothing in return, a McClatchy Newspapers analysis shows.

The Affordable Care Act tried to expand Medicaid to millions of low-income, uninsured adults. But many Republican-led states, including both Carolinas, opted out of the plan championed by President Barack Obama.

If the 23 states still rejecting Medicaid expansion stick with that decision, they’ll contribute $152 billion over 10 years to states that take the federal money, the analysis shows. North Carolina would be one of the top five contributors.

In other words, because of the refusal by Gov. McCrory, House Speaker Tillis and Senate President Pro Tem Berger to expand Medicaid, North Carolina is contributing to the utterly nonsensical situation in which it and other poorer states are subsidizing the provision of health care to low income people in wealthier states that have already expanded Medicaid.

The article also cites a pair of business economy experts for the proposition that the failure to expand is holding back the state’s economy: Read More