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Commentary

North Carolina’s uninsured rate fell in 2014 thanks to the implementation of federal health reform but data released today show our state is leaving many citizens behind by refusing to expand Medicaid.

The Census Bureau today released the country’s official data on health insurance rates, which shows that 1.27 million North Carolinians lacked health insurance in 2014 compared to 1.5 million uninsured North Carolinians in 2013. Expanding Medicaid would have resulted in a more dramatic drop in the uninsured rate.

We see that many of the states that expanded Medicaid such as West Virginia and Kentucky now have single-digit uninsured rates whereas North Carolina’s uninsured rate was 13 percent in 2014 compared to 15.6 percent in 2013. The Affordable Care Act is working, but it would work better if policymakers stopped blocking coverage for the working poor families who don’t earn enough to buy private insurance and don’t currently qualify for Medicaid.

A study by George Washington University released last year shows that expanding Medicaid in North Carolina would extend coverage to 500,000 more people while creating 43,000 jobs and attracting $21 billion in federal funding over five years.

Nationally, the Census data show that the uninsured rate dropped to 10.4 percent last year, down from 13.3 percent in 2013. These numbers reflect individuals who were uninsured throughout the year. The Affordable Care Act helped more than 8.8 million people gain health insurance coverage.

It’s not too late for North Carolina to catch up with the rest of the nation. The Governor could propose, and the legislature could adopt, a state-specific plan to close the coverage gap at any time.

Commentary

Medicaid expansionFor years now, poor and working North Carolinians who would benefit greatly from Medicaid expansion under the Affordable Care Act have been held hostage as Governor McCrory procrastinated and offered excuses. First, the Guv claimed that the Medicaid system itself was “broken” and in need of repair before it could be expanded. Then, he claimed that it would be inappropriate to act until the U.S. Supreme Court ruled on the constitutionality of the ACA itself.

Today, McCrory is running out of excuses. The Supreme Court took care of the constitutionality question a few weeks ago and yesterday, McCrory himself laid Excuse #1 to rest.

According to a statement from the Governor’s office, Medicaid is now in the black:

“The Department of Health and Human Services reported today that the North Carolina Medicaid program ended the 2014-15 state fiscal year with $130.7 million cash on hand. This is the second consecutive year the Medicaid program has finished with cash on hand.”

What’s more, that surplus is more than enough to cover state costs of implementing expansion. As a December 2014 study from health policy wonks at the Milken Institute School of Public Health at George Washington University reported (see page 15), expansion will actually save the state more than $300 million over the next five years. In 2020, however, there will be a modest net cost to the state of $91.7 million.

The obvious takeaway? Even if the state flushed away the savings that expansion will bring between now and 2020, it can easily cover the modest bump in costs in 2020 merely by socking away the current surplus.

Not surprisingly, however, the Guv is already moving the goalposts. Read More

Commentary

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!