Commentary

The truth about the Governor’s proposed “Medicaid expansion”

Medicaid expansionThere’s been a lot of talk of late emanating from the McCrory administration about “expanding Medicaid.” Unfortunately, a close look at the fine print makes clear that the minor proposed “expansion” has absolutely nothing to do with closing the state’s massive Medicaid coverage gap that has resulted from our failure to expand the program under the terms of the Affordable Care Act.

Both the North Carolina Medicaid and NC Health Choice Draft Section 1115 Waiver application written by the state Department of Health and Human Services (DHHS) and included in the Governor’s 2016-2017 proposed budget presentation use the word, “expansion,” freely. Unfortunately, neither the Governor nor DHHS have committed to closing the coverage gap or truly expanding Medicaid so that nearly one-half million North Carolinians can have access to health services. To be clear, closing the coverage gap means extending health coverage to individuals at or below 138 percent federal poverty level, which is an annual income of $16,394 for an individual and $33,534 for a family of four in 2016.

The 1115 waiver is for Medicaid “reform,” NOT Medicaid expansion. As you may recall, DHHS and the General Assembly want to transform our current nationally recognized primary case management system to managed care, where both commercial insurers and “provider led entities” would administer Medicaid services.

The waiver proposal reports that North Carolina will embark upon a tiny “expansion” of Medicaid whereby parents whose children enter the foster care system can access health care services in order to strengthen family stability. Unfortunately, this “expansion” is only for parents who already meet income eligibility for Medicaid when their children are in the home. Currently, once their children are removed from the home, parents previously enrolled lose their benefits. In other words, while welcome, all the proposed change does is alter a minor, extremely illogical rule.

What’s more, Read more

Commentary

Advocates, people in need demand closure of the Coverage Gap as Medicaid “reform” hearings commence

Medicaid expansionNorth Carolina’s Department of Health and Human Services has a busy few weeks ahead as it commences a series of public hearings around the state concerning its plan to privatize the state Medicaid program and obtain a waiver from the Federal government that would approve the scheme.

Yesterday, a large crowd attended the first public hearing session in Raleigh (click here to see the schedule and sign up to attend future public hearings). The hearing was attended by health care providers, administrators, advocates, current Medicaid enrollees, and individuals that would benefit from Medicaid expansion. Unfortunately, only two legislators, Rep. Marilyn Avila and Sen. Floyd McKissick Jr., were in attendance to hear what people have to say about reform.

One message that rang clear during yesterday’s event was that North Carolina cannot truly transform Medicaid without first expanding the program to the approximately 500,000 people in the Coverage Gap. At the hearing, roughly a third of all of the comments offered called for Medicaid expansion as has been done in so many other states under the terms of the Affordable Care Act. Speakers representing organizations such as the American Heart Association, Carolina Jews for Justice, the League of Women Voters, and even a student from NC Central University all spoke on behalf of the child care workers, construction workers, and home health aides that work, but are stuck in the gap.

Before opening the floor to public comment, DHHS Secretary Rick Brajer explained that he and his team have been “crowd sourcing the development of the waiver.” Brajer even presented a slide listing all of the key “stakeholders” that his department has met with during the preparation of the waiver request.

Unfortunately, one group that was clearly missing from the Secretary’s list were the people in the Coverage Gap. These voices need to continue to be heard as access to quality and affordable health care not only positively impacts individual and family health, but community health as well through job growth and economic development.

In the weeks ahead, look for more and more advocates and potential beneficiaries of expansion to speak out for this kind of genuine reform.

  • Providers will push for Medicaid expansion so that their patients will no longer have to rely on emergency care and actually be able to obtain primary preventative care.
  • Health administrator concerned with health care costs will push for expansion as states with expansion have seen a decrease of 26 percent in uncompensated care costs.
  • School teachers will push for expansion because they know that their students will have increased educational outcomes if their parents/caregivers receive Medicaid.
  • Business owners will push for expansion because good health is closely linked to job productivity .

For more information on how you can be a part of the effort to help push for Medicaid expansion and meaningful reform, click here to learn more about the hearings and here to submit comments online.

News

North Carolina’s infant mortality rate ticks up, with increases in black and Latino baby deaths

North Carolina’s infant mortality rate has ticked upwards, a slight setback in the state that once had the highest infant mortality rate in the nation.

The state’s 2014 rate was 7.1 deaths of babies in their first year for every 1,000 live births, according to information released Monday by the N.C. Department of Health and Human Services. In all, 860 infants died in North Carolina during 2014 before their first birthday.

That’s up from the 7 deaths for every 1,000 live births the state had from 2010 to 2013, the lowest the state’s rate has ever been.

But the data shows the state continues to have significant differences in how babies fared from different racial and ethnic groups, with death rates rising in the Latino and African-American populations while dropping for white and Native American babies. (Click here to access chart on racial breakdowns).

Graphic from Washington Post

Graphic from Washington Post

North Carolina’s infant mortality rate is higher than the U.S. average of 6 deaths per 1,000 births, while the United States has one of the highest infant mortality rates in the developed world.

A 2014 chart from the Washington Post shows just how far the United State lags behind many countries, largely European, when it comes to how  infants fare.

Here in North Carolina, black babies continued to face worse outcomes than their white, Latino and Native American peers, and the infant mortality rate increased to 12.8 deaths for every 1,000 births of African-American children after years of declines.

Latino infants, who have had some of the lowest mortality rates in the state for years, had an alarming 68 percent jump in the mortality rate, from 3.7 deaths for every 1,000 live births in 2013 to 6.2 deaths for every 1,000 births in 2014.

 

There were also geographical differences in the North Carolina data, with counties in the eastern part of the state (many of which also have the highest poverty rates in the state) exhibiting higher rates of infant deaths than found elsewhere.

From DHHS:

Infant Mortality by NC Policy Watch

NC Budget and Tax Center

Up to 105,000 childless adults in North Carolina would lose food aid in 2016 if legislators prohibit new waiver

North Carolina is the fifth hungriest state in the nation. Yet, the state Senate gave tentative approval to a bill that unnecessarily restricts food aid for childless adults who are very poor and live in areas where jobs are scarce—regardless of how hard they are looking for work.

States can temporarily suspend work-related time-limits on federal food aid for areas with sustained high levels of unemployment. North Carolina officials applied for a waiver in July for 77 of the state’s 100 counties due to a severe lack of jobs available that hampers North Carolinians’ ability to meet the work requirements (see map below). The Senate measure, however, would permanently ban the state from pursuing this option irrespective of how local economies are faring or whether employment and training opportunities actually exist.

Between 85,000 and 105,000 unemployed childless adults in North Carolina would lose food aid in 2016 because they can’t find a job if legislators prohibit the Governor’s administration from seeking a new waiver.*   Read more

Commentary

Chief reaction to Wos departure: Relief

well-timed tissueGov. McCrory may have shed a few tears yesterday over the departure of his Secretary of Health and Human Services, Aldona Wos, but the chief reaction across the state — both within government and without — was relief and a strong feeling of “what took so you long? This morning’s editorial pages tell the story:

Here’s Wos’ hometown Greensboro News & Record in an editorial called “Good heart, bad fit”:

“As for tangible results, well, that was another matter. Despite her background as a physician and former U.S. ambassador— and her famous, sunrise-to-late-night work ethic — the sheer weight of the DHHS bureaucracy seemed to overwhelm Wos.

In time, critics on both sides of the partisan aisle began to wonder out loud if they were getting their money’s worth.

Now, after two and half years at the post, Wos is leaving, Gov. Pat McCrory announced at a Wednesday news conference in Raleigh. Standing at his side, Wos noted it was ‘time to go home.’ Although the governor tearfully praised Wos’ job performance and commitment — as he has all along — her tenure has been wracked by a series of missteps and crises, large and small…”

The N&R then goes on to list a half dozen HHS disasters under Wos’ leadership.

Raleigh’s N&O put it this way in a piece entitled “Don’t cry for me North Carolina”:

“Some Republican lawmakers were annoyed by the turmoil in the department and Wos’ inability to provide reliable numbers on the cost of Medicaid. Senate Republicans even proposed that their version of Medicaid reform would remove the program entirely from DHHS and place its management under the control of a new agency. Indeed, lawmakers doubts about Wos may well have played a role in her resignation.”

The Winston-Salem Journal called for the department to be put back on track:

“The resignation Wednesday of Dr. Aldona Wos, the embattled secretary of the state Department of Health and Human Services, was as overdue as it was unsurprising.…During the two-and-a-half years she has served as secretary, legislators of both parties, advocates and state audits have repeatedly pointed out flaws in the department’s delivery of service to some of our most vulnerable citizens.”

Charlotte Observer cartoonist Kevin Siers compares the department Wos leaves behind to the Statue of Liberty — the torch section.

Meanwhile, the Fayeteville Observer took a different approach, noting that Wos’ departure provides a perfect time to expand Medicaid:

“When he explained why he declined to adopt Obamacare’s expanded Medicaid coverage two years ago, Gov. Pat McCrory said he couldn’t do it because the system was broken. Two consecutive years into positive fund balances, it doesn’t look broken anymore, does it? Where, then, is the expansion initiative, which would bring billions of federal dollars to North Carolina, insure hundreds of thousands of residents without coverage and likely save some rural hospitals from shutting down?”