Commentary

Physician from NC Senate leader’s district makes impassioned plea for Medicaid expansion

deny-medicaid-400x270In case you missed it, a veteran family physician from Senate President Pro Tem Phil Berger’s home county of Rockingham has authored one of the best new pleas for closing North Carolina’s Medicaid gap that currently keeps hundreds of thousands of working North Carolinians uninsured. In an open letter to Berger and Gov. Pat McCrory in the Greensboro News & Record, Dr. Stephen Luking offers several heartrending examples from his own practice about good, honest people whose health and life expectancy have been directly endangered as a result of the state’s stubborn resistance to Medicaid expansion. As he notes:

“These families aren’t ‘takers’ looking for a handout. The working poor are our cousins and our neighbors. They sit with us in the pews on Sunday; their children or grandchildren go to school with ours.

Some have watched well-paying jobs fly to Mexico or China. Some through personal or family circumstance earn meager wages. Some have employers who craftily maintain them under “temp” status or keep their hours worked under 30 hours per week to avoid insurance obligations. Some have reached their God-given potential.

Who are we to pass judgment? The fact is that near-poverty has left all of them uninsurable without Medicaid. Your rejection of Medicaid expansion may have earned you bona fides and high-fives in political circles, but in the real world your decision has harmed these families left and right.”

And here’s the powerful conclusion:

“Like any family doctor who has practiced for 30 years, I know what it’s like to make a decision that leads to the death of a patient. The appropriate intervention gone badly, the symptom after consideration mistakenly reassured. … I can tell you, it cuts like a knife. You face the family and fight back the tears. You wake up in the middle of the night in a cold sweat and wish you had that moment back.

And sometimes one night leads to a dozen. My wife will tell you, it’s a load to carry.

Gov. McCrory and Sen. Berger, you now carry that same weight, whether you will admit it or not. Welcome to this our unfortunate fraternity: those who carry the blood of others on our hands. Like it or not, we are all three members.

Some in Rockingham County will surely die — if some haven’t already — because of your partisan decision to reject Medicaid expansion.

Please embrace our shared humanity. The two of you have the power to get this done.

Re-approach this issue with an open mind and you will experience a change of heart.

Until then, I hope you’ll wake up some nights in a cold sweat, knowing you have committed a terrible wrong. Shame on you for your complicity thus far in denying basic health insurance to the most vulnerable residents of our state.

Shame on the rest of us for letting you get away with it.”

 

Commentary

AIDS Action Network advocate: Medicaid expansion is a life and death matter

PictureChristina Adeleke of the North Carolina AIDS Action Network recently had the opportunity to testify at a North Carolina Department of Health and Human Services public hearing on the McCrory administration’s plan to privatize the delivery of Medicaid services. Afterward, she composed a compelling and personal essay about how the reality of health insurance in 21st century North Carolina and the price people are paying because of North Carolina’s refusal to close the coverage gap.

FYI, there are two more opportunities to speak out at these hearings — tomorrow in Elizabeth City and Monday in Pembroke. Click here for more information.

The moment I realized that Medicaid reform was a “big deal”
By Christina Adeleke, Esq., North Carolina AIDS Action Network

I have to be completely honest, health insurance was not something I really thought too much about until I got older. Like, “you are finally an adult with bills so you need to think about this now” older. As a child, it was not something I actively thought about. One, I was a kid so health insurance was definitely not high on my priority list and two, I was not a “sick kid,” so I only really went to the doctor’s office when I had to get vaccinated or get a physical to play sports at school (which was also rare). It was not until I reached the magic age of 26 that I was faced with the harsh reality that health insurance is necessary. And very expensive.

Like most young adults, my first job did not immediately shower upon me loads of money. I made enough money for bills, essentials, and literally nothing else, including health insurance. When I tried to get coverage under the Affordable Care Act (ACA), the only plans that I qualified for were completely out of my budget. When I tried to apply for Medicaid, I was told that I made too much money to qualify but if I had a child, things would be different, which was puzzling to me. Did the fact that I had a child or not change my very real reality of not being able to afford health insurance? Before I had too much time to seriously weigh those options, I got offered a new job…WITH BENEFITS. To say I was excited would be an understatement. Now, I did not have to load up on vitamins to prevent myself from getting sick or entertain the idea of having a child in order to get health coverage. I assumed that everyone who was struggling to get health coverage was like me and when they found the right job or opportunity, they too, would be covered as well. I was very wrong. Read more

Commentary, News

Yet another sign that Obamacare is helping the people who really need it

The Washington Post has still more encouraging news about the beneficial impact of the Affordable Care Act:

People enrolled in health plans through the Affordable Care Act exchanges are ramping up their use of prescription medications more rapidly than those in employer or government-sponsored plans, according to a new report from Express Scripts, the largest prescription drug benefits company.

In 2015, people in the exchanges increased their number of prescriptions filled by 8.6 percent, four times the rate of people who receive insurance through commercial plans outside of the exchanges. That, along with price increases, led to a 14.6 percent jump in drug spending for people in the exchanges, nearly three times faster than all drug spending. The findings are based on Express Scripts data, which includes about a third of the pharmacy claims filled by all people insured through the exchanges.

This “has impact for insurers who are going to want to manage this program, given that people who need more care are more likely to join the program,” said Glen Stettin, senior vice president and chief innovation officer at Express Scripts. “If they want to continue to have an affordable benefit, they’re going to have to manage this tightly.”

Although the growth in spending and use of prescription drugs was faster for patients in the exchanges than for those in commercial plans, the overall amount spent was much lower per person — $777.27 compared to $1060.75.

The rapid uptake of the prescription drug benefit suggests there was a significant unmet medical need for many people gaining insurance through the exchanges, some of whom could have preexisting conditions and may not have previously had access to medicines. Before 2014, insurance companies could refuse coverage or charge much higher premiums for people with preexisting conditions, a practice largely forbidden under the Affordable Care Act. An April 2014 report from Express Scripts found that people insured through the exchanges were four times more likely to have a prescription for an HIV medication than those in commercial plans.

In other words, more confirmation that more Americans are getting the care they need and that the ACA is succeeding in promoting longer, healthier lives for millions of people. Click here to read the entire article.

News

What Scalia’s death means for the current SCOTUS term (updated)

IMG_0182These things became abundantly clear within hours of the death of U.S. Supreme Justice Antonin Scalia.

President Obama intends to meet his constitutional obligation of filling the vacancy on the court as soon as possible, by naming his choice and sending that candidate to the U.S. Senate for approval.

Republicans in the Senate intend to do everything in their power to block any such appointment, arguing that that should be the prerogative of the next president.

And in the midst of what’s already shaping up to be an historic general election cycle, Americans are about to get a lesson on the critical importance of the presidential judicial appointments power and the impact the Senate’s obstruction of that power has had in recent years.

The President theoretically can make a recess appointment to the high court (former Justice William J. Brennan, Jr., got his start on the court that way), but as Lyle Denniston at SCOTUSblog notes, the Court last term restricted that recess appointment power to the point where the Senate controls what constitutes a “recess.”

And given the already-announced recalcitrance by the leaders of that body to an Obama Supreme Court nominee — especially now — the qualifying recess is unlikely to happen.

In the short term then, what does an eight-justice court mean for cases before the nation’s highest court?

The justices will continue with the term, deciding cases already argued, hearing those set for argument and reviewing new requests for review (likely for argument next term), along with requests for emergency relief — including North Carolina’s pending petition for a stay of last week’s federal order requiring a redrawing of the congressional voting map by Feb. 19.

In cases in which Scalia has already voted but an opinion has not yet been announced, his vote is void and the decision then turns on how the other justices have voted. 

Where there’s a 4-4 split, the justices could let the decision of the lower court from which the appeal arose stand, as Tom Goldstein at SCOTUSblog notes here, “affirmed by an equally divided Court.” Such a decision has no precedential effect, though.

Or they could schedule the case for reargument in the term that begins next October with the hope that a full court could decide the issue at hand.

Plenty of controversial cases remain pending at the high court for decision this term — some already argued — in which a 4-4 split decision is possible. They include abortion rights in Whole Womens Health v. Ellerstedt, affirmative action in Fisher v. University of Texas, redistricting one person one vote in Evenwel v. Abbott, union fees in Friedrichs v. California Teachers Associationdeferred action for immigrant parents (DAPA) in United States v. Texas, and religious exemptions to the Obamacare contraceptive mandate in Zubik v. Burwell.

(For the specific impact predicted in these and other cases, see the New York Times graphic here.)

North Carolina has its own share of controversial cases that will work their way to the Supreme Court — most notably the redistricting cases pending in state and federal court and the voting rights cases before Judge Thomas Schroeder — but none of those are on the high court’s docket for decision this term.

The biggest impact the Scalia vacancy will have on those cases will be on emergency applications for relief from court orders — as in the current federal congressional district case, and possibly in the federal legislative district case, should a similar map-redrafting order — as well as in the voting law case, should Schroeder or the Fourth Circuit on appeal require changes.

###

(Note: This post has been updated to add as an option for the court this term the rescheduling of split decision cases for reargument next term in the hope that a full court can rule determinatively — as opposed to letting the decision of the court below stand.)

Commentary

Context is key for understanding Insurance Commissioner’s Affordable Care Act comments

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.