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Medicaid expansionMedicaid — the absurd failure to expand it at federal expense for a half-million low-income North Carolinians and the state Senate’s latest remarkable proposal to slash the program still further– remains front and center in the state policy debate these days. Moral Monday protesters highlighted the issue last night and the real life stories of average working people whose lives are darker and shorter because of legislative leaders’ Scrooge-like behavior continue to pour in. Tomorrow, activists from an array groups will gather at the General Assembly to lift up this most obvious of issues once again.  Here’s yet another story that makes the case from the good folks over at Women AdvaNCe and Planned Parenthood:

Stuck in the Medicaid gap
By Emily Callen

A few weeks ago, while talking to people about Medicaid expansion at a festival in downtown Raleigh, I met Linda. Though she seemed tired after a day at work and was probably eager to change out of her Bojangles uniform, Linda took the time to talk to me. “I really need this,” she said, filling out a postcard urging legislators to take action. “I tried to sign up for Obamacare but it was just too expensive.”

I learned later that Linda, who considers herself generally healthy, had been in a car crash last December. Broken bones kept her out of work for a few weeks, and she still sees an orthopedist because her collarbone hasn’t healed yet. Since Linda doesn’t have insurance, she’s worked out a deal to pay her doctor a little bit each month. It will take her a long time to pay off the bill, and in the meantime she will continue to struggle to make ends meet.

Linda’s experience is not uncommon. She is one of over 300,000 North Carolinians who fall into the Medicaid Gap; Read More

Last October Gov. McCrory caused a stir, and raised some eyebrows, when he said that the state may be forced to expand Medicaid due to a “new” regulation.

The policy to which he was referring is called presumptive eligibility. Presumptive eligibility allows states to give permission to hospitals and other providers to temporarily enroll certain people in Medicaid. North Carolina, for example, allows presumptive eligibility for pregnant women. That means if a hospital does an initial check and it looks like a pregnant woman is likely to qualify for Medicaid then the hospital can temporarily enroll her and get paid for the services it provides. Meanwhile, an application for full Medicaid can be processed without a disruption in care.

This policy is critical for ensuring that patients get care and providers get paid.

In states with efficient systems that can process Medicaid eligibility in real time, this temporary measure is not as important. In states where parents are having to ration medicine for their children due to a backlog in processing Medicaid applications, presumptive eligibility is a critical tool.

Health reform gave hospitals more latitude to presumptively enroll patients, even if the state has not granted the hospital permission to participate in the program. Other providers, notably Community Health Centers, however, are still not able to use presumptive eligibility to enroll children in Medicaid. The Community Health Centers are still limited to enrolling pregnant women.

Ultimately, the state needs to fix its computer system. In the meantime, we need to get care to children. We could start by granting Community Health Centers, and possibly other providers, the ability to temporarily enroll likely eligible kids in Medicaid while DHHS clears its application bottle neck.

And until the state expands Medicaid to all low-income people we will need every splint and bandage we can find to patch our broken system.

 

 

With the growing success and momentum of the Affordable Care Act, it’s increasingly evident that opponents have lost the national debate. The national media are now overflowing with stories about how the right is desperately searching for a new issue to focus on during the upcoming fall elections.

Here in North Carolina, where conservative obstruction continues to hold sway for the time being — at least with respect to a federally-funded Medicaid expansion for 500,000 low-income people — we’re also seeing growing signs that the blockade is starting to crack and crumble.

The newest evidence of the occurred this week at the General Assembly where ACA opponents ran headlong into advocates for people with autism. As Adam Linker explained here the other day and Raleigh’s News & Observer explained this morning, the advocates are fighting for health insurance coverage of Autism Spectrum Disorders are running into opposition from the corporate lobbying community, which as usual, is doing everything in its power to save itself money and limit coverage.

The interesting twist is that the debate over autism coverage has served to help bottle up a conservative anti-ACA bill that would also ban new insurance mandates.

In other words, the efforts of lawmakers to pass another anti-ACA law has been revealed yet again to have an Achilles’ heel — namely, that people want health insurance. Try as they might to undermine the new law, ACA opponents cannot overcome the simple on-the-ground reality that Americans of all stripes want coverage for themselves and their families and will not — in the long run — allow politicians to deny it to them. The debate over autism coverage at the General Assembly is just the latest example of this powerful reality.

Politicians and members of the press are keenly interested in premium rates for Affordable Care Act Marketplace plans next year. Lawmakers want to use insurance prices as a cudgel on the campaign trail and the media knows that talk of premium spikes will attract attention.

That’s why reporters were interested in the announced enrollment statistics for Blue Cross and Blue Shield of North Carolina on Friday. The resulting coverage noted that BCBSNC enrollees were older and sicker than the company expected. In the race to make political hay out of these numbers there are a few points to keep in mind.

First, approximately 91 percent of ACA plan enrollees in the state receive a subsidy to purchase coverage. For this population premiums are capped as a percent of income. If, for example, you earn 150 percent of the federal poverty level then you will need to pay 4 percent of your household income for an ACA plan regardless of how premiums behave. Unless your income changes, you will pay the same rate next year.

Second, an older risk pool is not a major driver of premiums. Insurance companies certainly need younger and healthier enrollees to balance out payments for customers who use a lot of medical services. Still, as Kaiser Family Foundation has pointed out, even if insurers miss the mark substantially, this less healthy risk pool will only have a 1 or 2 percent impact on premiums. The primary drivers of premiums continue to be underlying medical costs and negotiated payment rates to providers.

Third, insurance companies have an interest in talking up their bad risk and steep medical costs. Insurance companies are, after all, companies. They want to set rates as high as the market will allow yet they also have to justify premium hikes to regulators. So, if they begin preparing the public for large premium increases the companies can then blame older and sicker enrollees for the requested boost in rates. Insurers also use the poor risk pool when negotiating with hospitals to explain cuts in payments for certain services. This is not to impute ill will to the insurance companies. It’s just how the game is played.

The risk pool mix, premium increases, and changing medical costs are all critical policy issues. We must restrain the rise in health care costs because, in the end, we all pay for our unnecessarily overpriced system. But when you hear that ACA Marketplace premiums will increase next year keep this context in mind.

While millions of dollars have been spent to tie incumbent U.S. Senator Kay Hagan to her support of the Affordable Care Act, there are now signs that Republican strategists may be moving away from making the health care law the singular issue of the 2014 campaign.

Think Progress reports it’s becoming increasingly difficult for some critics to keep up the drumbeat against the ACA:

‘Republicans called a House hearing on Wednesday with health insurance companies in an effort to embarrass the White House with revelations about double digit premium increases and claims that one-third of federal exchange enrollees still haven’t paid their health insurance premiums. Instead, the insurance leaders calmly explained that premiums for next year were still being calculated and that more than 80 percent of enrollees have in fact sent in their first-month checks.

One insurance company CEO even observed that while President Obama’s claim that if you like your health insurance plan you can keep it did not apply to everyone, the promise held true for “99 percent of our customers.” As The Hill observed, “Republicans were visibly exasperated as insurers failed to confirm certain assumptions about ObamaCare” and many simply exited the hearing.’

During Thursday’s confirmation hearing for Sylvia Mathews Burwell to head the U.S. Department of Health and Human Services, Senator Richard Burr avoided further attacks of the health care law, instead offering glowing remarks for President Obama’s HHS nominee. The New York Times reports:

‘Senator Richard M. Burr, Republican of North Carolina, said he intended to vote for Ms. Burwell because she had “a portfolio of experience that would make her a tremendous asset” to the Department of Health and Human Services.’

Political science professor David McLennan of William Peace University also sees the continued ACA attack losing some of its luster as the public becomes more comfortable with the law and the impact on their own lives.

“The question is: Will the Republicans continue that line of attack against Kay Hagan or try to find some other issues?  I think if they continue the Obamacare attack, it’s not going to be particularly effective.”

For a preview of McLennan’s weekend radio interview with NC Policy Watch’s Chris Fitzsimon, click below:

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Americans now appear to be evenly split in their opinion of the Affordable Care Act. A recent Christian Science Monitor/TIPP poll finds 47 percent of American adults support the law and 47 percent oppose it. But it’s worth noting public support has jumped seven percent from late March to late April, according to that poll.