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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, News

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.”

Commentary

At yesterday’s NC Policy Watch Crucial Conversation luncheon, Dr. Lonise Bias, the mother of famed basketball star Len Bias who died tragically in 1986 from cocaine abuse, told of her journey from the tragedy of losing two sons to becoming a national spokesperson for the cause of combating substance use disorder. Dr. Bias was joined at the event by by Jeff Matkins, one of North Carolina’s  leading advocates for expanding Medicaid under the Affordable Care Act to help provide health coverage to tens of thousands of North Carolinians battling addiction.

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News

Health careThe U.S. Supreme Court has agreed for a fourth time to wade through an Obamacare dispute, this time in several consolidated cases involving the contraceptive mandate.

This from the Associated Press:

The newest “Obamacare” case involves objections by faith-based hospitals, colleges and charities to the process the administration devised to spare them from paying for contraceptives for women covered under their health plans, and yet ensure that those women can obtain birth control at no extra cost.

The groups complain that they remain complicit in making available the contraceptives in violation of their religious beliefs.

Seven out of eight federal appeals courts have agreed with the administration that requiring the faith-based groups to make their objection known and identify their insurer or insurance administrator does not violate a federal religious freedom law.

Argument in the cases is expected in March 2016.

Commentary

Action NC policy and public affairs director Kevin Rogers has an opinion piece in the News & Observer arguing that the ACA is here to stay, so we should get down to the business of improving the law and fully implementing it in North Carolina.

Open enrollment, he reminds us, starts November 1. Our state is a national leader when it comes to signing up residents for Affordable Care Act plans. The many people who have these policies need added protections, not repeal votes, to make their insurance plans work better. And the working poor need our state leaders to stop blocking Medicaid expansion. This interposition is causing great pain, and unnecessary deaths, all across North Carolina.

You can read the entire editorial here. Rogers concludes with this message to lawmakers:

As we enter the third ACA enrollment period, it is high time for Congress and the General Assembly to accept reality, abandon partisan tricks and move forward to improve the economic and human well-being of our state. Until then, thousands of lives will be lost each year, and billions of dollars wasted that health care consumers, taxpayers and our government cannot afford. The ACA is here to stay – it’s time to start acting accordingly.

If they heed his advice that would be sweet indeed.