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mc-1Governor Pat McCrory emerged from his much-publicized meeting with a handful of other governors and President Obama at the White House  Tuesday breathlessly declaring that Obama is open to considering waivers to allow North Carolina to crafts its own version of Medicaid expansion under the Affordable Care Act.

But that shouldn’t be news to McCrory or anybody else.  Nine states, most of them with Republican governors, have already expanded Medicaid with waivers from the feds or have been in discussions with the Obama Administration about waivers for their own versions of the program.

Neighboring Tennessee is the latest state with Republican leadership to move forward, with Governor Bill Haslam unveiling a proposal for Medicaid expansion last month. 

Apparently McCrory had to fly to Washington to figure out that the Obama Administration was willing to work with state officials who are developing their own Medicaid plan.  Or maybe he just wanted us to know he was talking tough with Obama.

I presented a very strong argument for more flexibility if we even consider Medicaid expansion, so we can have a North Carolina plan instead of a Washington plan, and especially a plan that would encourage more people to get a job or get training before we expand another government program,” McCrory said after the meeting.

While it’s too bad it took McCrory much longer than many Republican governors to realize the Obama Administration was willing to work with the states to provide health care for people who need it, at least he seems to finally understand it.

There’s also the head-scratching logic that more people will have to get a job before Medicaid is expanded, as if only people who are working need to be able to see a doctor, not to mention the people with chronic illnesses whose lack of access to treatment prevents them from working in the first place.

But maybe now McCrory can get on with what he should have done already, following the lead of his Republican colleagues across the country by expanding Medicaid in North Carolina and providing health care coverage for several hundred thousand low-income people and creating thousands of jobs in the process. It is past time.

Commentary

A new report from Cone Health Foundation and Kate B. Reynolds Charitable Trust finds that North Carolina lost out on billions of dollars and thousands of jobs by refusing to close the Medicaid coverage gap in 2014 and 2015. If the state acts in 2016, however, we can recoup some lost ground by covering 500,000 more people. Such a move would create 43,000 new jobs by 2020 and reap $1 billion in tax revenue for the state and counties. Closing the coverage gap would save the state budget more than $300 million by 2020.

As followers of this blog know the state had a chance, starting in 2014, to expand Medicaid eligibility to all individuals and families earning less than 138 percent of the federal poverty level. More than half the states have now opted into this deal and they are attracting a huge return on investment. This new report is the first of its kind in the nation that takes a detailed look at every county in the state and uses a nationally respected model to estimate the impact of Medicaid expansion on tax revenue, job creation, business activity, and coverage.

The results are startling. In Robeson County expanding Medicaid would generate more than 700 jobs. In Moore County it would create nearly 500 jobs. In Nash County it would create more than 300 jobs. This is the equivalent of a fleet of new large employers locating in dozens of communities across the state. The increased economic activity will produce more county tax revenue at a time when many local governments are sputtering by on fumes. For Wake County, Medicaid expansion would net more than $25 million in tax revenue. It would earn Guilford County more than $11 million.

New data confirms in finer detail what we have always known, expanding Medicaid eligibility is a no-brainer. Thankfully, Gov. McCrory seems to be moving to the right (or should I say correct) side of this issue. Now that the federal government is allowing governors and legislators the flexibility to design state-specific expansions Wyoming, Indiana, Utah, and Tennessee — hardly redoubts of liberalism — are starting to embrace expansion. We should follow suit.

This is a rich report that deserves a close reading. You can find some reporting on it here, here, here, and here.

 

 

Commentary

healthcare.govIf you don’t have affordable health insurance through an employer then now is your chance to shop for a plan on the individual market. New options are now available and many people can get help paying premiums. In fact, in 2014 more than 90 percent of people who enrolled in an insurance plan through healthcare.gov in North Carolina received financial assistance, and of this group the average premium was $80 per month. This is for a comprehensive policy.

The current open enrollment period  stretches until February 15, 2015, but if you want your benefits to start on January 1 then today is the day to purchase a plan. This is true no matter when you bought insurance in 2014.

The website is working smoothly these days but you don’t have to navigate the process by yourself. Plenty of health insurance agents are ready to assist you. Also, application counselors and navigators based at nonprofits around the state can help. They are all volunteers or grant funded and have no financial incentives to steer you toward any particular company or plan. You can check out this website to find help in your area. You can also call 1-855-733-3711.

It is especially important to shop around even if you bought a policy. If you don’t actively switch plans then you will be automatically reenrolled. But with new options and more companies competing in the state reenrollment is unlikely to get you the best deal. As with most products, you need to shop around.

Another reason to buy a policy today is that you aren’t stuck with the plan you choose. To prevent a gap in coverage you can purchase a policy now and continue investigating your options during open enrollment. As long as you act before February 15 then you can opt for a different plan. Last year once you chose a policy you were stuck. This year you can change plans during the entire open enrollment period.

Unfortunately, many people trying to obtain coverage will discover that they fall into the Medicaid gap in North Carolina. Because the state legislature has refused to expand Medicaid working families earning less than 100 percent of federal poverty level may still find coverage unaffordable, and they won’t get help paying premiums. If our lawmakers choose to act in the next legislative session then most struggling citizens will be able to obtain comprehensive insurance.

 

 

Commentary

Reporter Dylan Scott at Talking Point Memo has the details of another wonky but important way that the Affordable Care Act is succeeding in holding down health care costs:

The medical-loss-ratio requirement mandates that insurance companies spend at least 80 percent of premiums on actual health benefits. It is one of the various provisions intended to help shape the behavior of insurance companies, making the market more efficient and cost-effective for consumers. Administrative costs are kept down, meaning that more of people’s money is going to real care.

“The medical loss ratio requirement and rate review mandated by the ACA put downward pressure on premium growth,” officials from the federal Centers for Medicare and Medicaid Services wrote in their report. Overall private insurance spending, of which premiums are a part, grew at a 2.8-percent rate — the lowest since at least 2007.

As Larry Levitt, vice president at the non-partisan Kaiser Family Foundation, put it to TPM in an email: “That is how it’s intended to work.”

In other words: Still more evidence that the ACA is insuring more people (and thereby saving tens of thousands of lives) and holding down overall health care costs.

Click here to read the entire story.

 

Commentary
Hisemug

State Senator and Mayland Community College “Coordinator of Special Projects,” Ralph Hise

Sensing building momentum for the expansion of Medicaid under the Affordable Care Act that would both cover hundreds of thousands of uninsured low income North Carolinians and bolster the state’s economy with billions in federal dollars, right wingers appear to have launched a new campaign of propaganda and distortion.

A prime example is this article on conservative website known as Watchdog Wire. In it, the author revives and recycles multiple absurd untruths about the supposedly ginormous cost to the state of Medicaid expansion — which she attributes to State Senator and Mayland Community College “Coordinator of Special Projects,” Ralph Hise. According to the article:

“the state would have to cover administrative costs to the tune of $2 billion per year. That’s a ’50-50 split’ said Hise.”

This is utter nonsense. As this detailed analysis by the North Carolina Institute of Medicine shows on page 5, the financial impact to the state from 2014 to 2021 if the it expanded Medicaid under the ACA is a net savings of $65 million. Hise’s “$2 billion” claim is simply out-of-thin-air malarkey.

The article also quotes Hise for the following supposedly damning criticisms: Read More