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altered-state-bannerIn case you missed it, be sure to check out today’s third installment in our new special report: “Altered State: How 5 years of conservative rule have redefined North Carolina.” Today’s story, “Yanking away the ladder: Legislature blocks and cuts programs that help people climb out of poverty,” is written by reporter Sarah Ovaska-Few and it tells the real life stories of average North Carolinians who have suffered mightily as the result of the anti-government policies implemented by the state’s conservative political leadership. Here’s the opening:

“David Turner’s spine and back issues cause him nearly constant pain and distress, keeping him inside his house most days and unable to meet with clients for his web design business or care for his two children.

A medical test would clear Turner for steroid shots to lessen the pain, but the $5,000 price tag is too steep for the Gaston County family with an annual income of less than $20,000 and no health insurance.

The Turners are stuck in what’s known as the Medicaid expansion gap, a hole created when North Carolina’s legislature rejected federal money that would have expanded the program to cover a half-million of the state’s lowest-income adults.

The Turners essentially make too little to qualify for federal subsidies that would make health insurance on the open market affordable and aren’t sick enough to get health care through the existing Medicaid program, which primarily serves low-income children, elderly and disabled persons. (Their children are enrolled in Medicaid.)

‘We’re hanging on by a thread,’ said Karen Turner, who has diabetes but delayed treatment so the family can afford her husband’s pain medications.

If David Turner had access to medical care, there’s a good likelihood that he would be able to work more, earn more, pay more taxes and better support his family. North Carolina is one of 20 states that has not expanded its Medicaid program to cover poor adults, even though the federal government would cover most of the costs. North Carolina accounts for 10 percent of all the nation’s adults that fall into the Medicaid gap, according to the Kaiser Family Foundation.

A central element in the five-year reign of conservatives has been a fundamental change in how state government views and treats its poorest and most vulnerable citizens. The 2013 decision to reject Medicaid expansion is part of a broad effort to cut, limit or eliminate programs that provide ladders to help poor families climb out of poverty and find better futures.”

Click here to read the entire story.

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.

Commentary

MedicaidThe endless 2015 legislative session appears, mercifully, to be nearing a conclusion after nine long months. With the passage of the budget early this morning, legislators are now free to wrap up final details and adjourn for the year. Unfortunately, one of those final details will be giving away the state’s award winning Medicaid program to giant, for-profit insurance companies. As Lynn Bonner reports this morning in Raleigh’s News & Observer:

“Legislators have agreed to privatize North Carolina’s $15 billion Medicaid program, a change that doctors and hospitals have been fighting for months, but which some Republican legislators have championed as a remedy for unpredictable spending.

Under House bill 372, three insurers would be given contracts to offer statewide Medicaid managed care plans. The state would have up to 10 contracts with “provider-led entities,” or groups of doctors and hospitals, that would enroll patients in regional managed care networks.

Rather than pay for each hospital visit or medical procedure as it does now, Medicaid would give the companies a fee for each patient when they enroll. The government would not be liable for cost overruns.”

In many ways. of course, this is a perfectly apt conclusion to the session. The 2015 session opened nine long months ago with one obvious and overriding imperative: North Carolina needed to follow the lead of 30 other states and expand Medicaid under the Affordable Care Act. Such an act would have saved thousands of lives per year, pumped billions of dollars into the state’s economy and strengthened an already highly effective program. The state’s feckless governor admitted these facts at times even as he manufactured excuses not to act.

Now, however, the decision has been made to, essentially, do the opposite. Rather than expanding the program to save lives, state leaders will heed the siren song of fat cat corporate lobbyists and give away this enormously valuable public asset to a handful of giant corporations that will, in turn, squeeze profits out of it by denying services to people in need.

The bottom line: More poor people will die, our economy will suffer unnecessarily and wealthy, out-of-state corporations will pad their profits. It’s hard to think of a concluding act that better symbolizes the awful 2015 session.

Commentary

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In January, over half of all those that participated in the Kaiser Health Tracking Poll were unaware of a Supreme Court case, King v. Burwell , that could greatly impact many states’ economic growth and public health. What has made the Affordable Care Act successful is that individuals are able to receive financial help to purchase insurance plans and depending on the outcome of this case, many people may lose this assistance in states that rely on the federal marketplace instead of a state-run marketplace. The decision of the King v. Burwell case could potentially affect 1.6 million North Carolinians’ ability to access affordable health care. Approximately 560,000 North Carolinians have purchased insurance coverage using the federal marketplace and are at risk of losing subsidies that would then make health care too expensive. What is more, the King v. Burwell decision is linked to expanding Medicaid to nearly 500,000 people throughout NC as Governor McCrory has stated that he will wait until the Supreme Court decision before making a formal decision on Medicaid expansion. We also know that a dramatic shift in enrollment will have a major impact on private insurance companies that will likely drive rates up by 43 percent for everyone. Some insurers may pull out of the market altogether.

Leaders in many red and blue states are concerned about the potential impact of losing insurance subsidies, and they are creating response plans. Let’s hope this process is playing out behind-the-scenes in North Carolina as well. The same Kaiser poll reports that 82 percent of Democrats, 63 percent of Independents, and 40 percent of Republicans believe that the U.S. Congress should act to make sure that low-and-moderate income families continue receiving tax credits to purchase affordable insurance even if the Supreme Court strikes down subsidies. However, states do not have to rely on the federal government to pass a law to ensure access to affordable health care; some states are already preparing to develop state-run exchanges. Nationally, 51 percent of Republicans, 63 percent of Independents, and 61 percent of Democrats believe that states that rely on the federal marketplace should create their own state-run market places. North Carolina’s Governor and General Assembly should take the initiative and start constructing our own state exchange. If the Supreme Court decides not to uphold the subsidies for low-to-moderate-income individuals who rely on the federal marketplace, it’s not clear that NC has a plan. Across the U.S., 63 percent of people believe that Republicans do not have an alternative to the ACA. Our state can’t wait on Congress to come up with a solution. Waiting to act until a Supreme Court decision in mid-to-late June is risky and could leave many North Carolinians without health care and our insurance market in ruins.

Commentary

The wonks at the Center on Budget and Policy Priorities are out with a new and powerful report today on the increasingly-evident benefits of Medicaid expansion. Here’s the lead:

“In the short time since states have been able to expand Medicaid to low-income adults under health reform, a clear divide has emerged between states that have expanded Medicaid and those that have not. Since the major coverage provisions of the Affordable Care Act (ACA) took effect in 2014, insurance coverage rates have improved across the country, but the gains are far greater in the states that have expanded Medicaid. As a result, hospitals in expansion states are treating fewer uninsured patients, and the amount of uncompensated care they are providing is declining steeply. Moreover, contrary to critics’ claims that Medicaid expansion is financially unsustainable for states, there is increasing evidence that expansion has saved states money, and these savings are expected to grow over time.

The Medicaid expansion has had an especially dramatic impact in Arkansas and Kentucky, which both had high uninsurance rates and limited Medicaid eligibility for non-elderly adults before health reform. Both states’ uninsurance rates have fallen by half in just over a year, and the expansion is expected to save each state more than $100 million by the time their current state fiscal years end on June 30.

Meanwhile, the states that have not expanded Medicaid are falling further behind. In the non-expansion states, large numbers of low-income people remain uninsured and without access to affordable health coverage. These individuals are caught in a ‘coverage gap’ because their incomes are too high for Medicaid but too low for subsidies to purchase coverage in the marketplace. Hospitals in these states continue to provide large amounts of uncompensated care, and the states are missing the opportunity to leverage billions of dollars in new federal funding through the Medicaid expansion.”

Click here to see the numbers and read more details about how North Carolina continues to fall farther behind as the result of its stubborn and self-destructive refusal to expand the program.