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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.

Commentary

Medicaid expansionThanks to a report from the American Mental Health Counselors Association, North Carolina along with other states that have not expanded Medicaid have yet another feather to place in their caps – denying access to mental health care for nearly 600,000 uninsured adults that would have sought care last year. Approximately 21,000 of those uninsured adults reside in NC. Even before the debate over Medicaid expansion began, there was the Mental Health Parity and Addiction Equity Act, which has produced a slow push to lessen the gap between how people access and utilize physical and mental health care. Even with mental health parity, over 50 percent of adults with a mental illness did not receive mental health care in NC between 2009-2013. Failing to extend health coverage to individuals with mental illness through expanding Medicaid only increases barriers to treatment, which in turn creates social, physical, and economic burdens to those with mental illness, their families and even their communities.

On the individual level, people living with mental illness are more likely to have other physical chronic conditions, have shorter life expectancies, are poor, and have difficulty finding employment. Students with mental illness, especially those who receive special education, experience school failure and drop out more frequently than other students including students in other disability groups . Without affordable mental health treatment, people with mental illness do not receive preventative treatment and thus rely on costly emergency room visits or even end up in jail.

The families of individuals with mental illness also face burdens as they become caregivers and help pay for expensive out-of-pocket mental health treatment. Unfortunately, the impact on communities resulting from traumatic events like Sandy Hook and Newtown have become too familiar that even the NRA supports policy to enhance the mental health system. On the broader economic level, the National Alliance on Mental Illness reports that the US loses $193.2 billion annually due to lost earnings associated with the sequelae of mental illness.

Treatment received from the public mental health system is especially important as people with mental illness live closer to the poverty line and have unstable employment status. For adults between ages 21 and 64 years that received mental health treatment from the public mental health system, 75 percent were unemployed. For all adults over age 18 that received treatment in the public mental health system, 76 percent reported improved functioning as a result of care. The statistics on employment and mental health may lead some to believe that expanding Medicaid will act as another “handout,” but most adults with mental illness want to work, but lack support to maintain employment. Further, some jobs obtained by adults with mental illness may not offer health care coverage or pay enough to cover out-of-pocket costs. Last year, in states that expanded Medicaid, there were nearly 350,000 fewer people that experienced Major Depression. Hopefully NC legislators will help decrease the burden of untreated mental illness by increasing mental health parity through Medicaid expansion.

Poverty and Policy Matters

There are few situations in life that are clearly win-win. When you see one, you have to take advantage of it.

That’s why North Carolina should reverse course and expand Medicaid. When you have the chance to improve health care for hundreds of thousands of people and actually save money, you should jump on it.

In a recent News & Observer editorial, the paper called the decision not to expand Medicaid “wildly irresponsible and hugely expensive.” That’s precisely correct, and let’s explore the first part of the statement a bit more.

Turning down Medicaid expansion turns down $50 billion in federal funding and prevents roughly 400,000 of our neighbors from getting covered. That makes expanding Medicaid an obvious choice.

But also consider that preventative care saves money over the long run. Insuring people means they get to go to the doctor, which means we pay less to prevent disease. This leads to lower costs for taxpayers and better lives for our people. An excerpt from the N&O piece:

Community Care said in a news release: “The medical costs for low-birth-weight babies average $49,000 in a baby’s first year of life, or more than 10 times more than babies born without complications. A low birth weight also increases a child’s risk for long-term medical and developmental complications and the likelihood of incurring additional expenses for social services and educational needs in later years.”

Kate Berrien, manager of Community Care’s pregnancy project, said North Carolina now leads the South in having the fewest births before 39 weeks. That’s a lot of savings and a vast increase in the quality of life for many children born to low-income mothers. And it’s an achievement attributable to innovations in community-level care that were developed in North Carolina and are being adopted across the nation.

It’s a win-win situation. Tom Wroth, CCNC’s chief medical officer, said, “We’ve been able to align improving clinical quality with lower cost.”

Read that last paragraph again. Improving quality care with lower cost is a win-win. So is expanding Medicaid.

Commentary

Medicaid expansionIn case you missed it, the best editorial of the weekend dealt with the most important failure of North Carolina’s political leadership in recent years. The essay in Raleigh’s News & Observer was entitled:

NC losing funding and savings with Medicaid holdout: By balking on Medicaid expansion, N.C. forgoes billions of dollars and a chance to cut costs.”

As the editorial noted:

“In medicine, the small things can matter most. And it is the neglect of the small things that can lead to the biggest costs.

That’s why preventative care is so important and early intervention so significant. And that’s why North Carolina’s stubborn refusal to expand Medicaid is so wildly irresponsible and hugely expensive. As a result of its intransigence, the Republican-led General Assembly is struggling to find tax revenue on one end and turning away billions of dollars on the other.”

The piece goes on to explain how North Carolina’s award-winning nonprofit Medicaid manager, Community Care NC, is saving millions upon millions of dollars and thousands of lives already and to lament the toll in both categories that is being taken by the state leadership’s pigheaded refusal to close the Medicaid gap for hundreds of thousands of lower-income, working people. It also cites report which holds up the astounding amount in federal funds the state is foregoing:

“The report estimates that forgoing federal Medicaid expansion from 2013 to 2022 will cost North Carolina $39.6 billion. In addition, the state’s hospitals will lose out on $11.3 billion in federal funds intended to offset cuts in their Medicare and Medicaid reimbursements as required under the Affordable Care Act, which anticipated that all states would expand Medicaid.

That’s more than $50 billion in federal funding forgone over 10 years. Meanwhile, the state would have to spend about $3 billion for its share of expansion. That is a mindboggling deal to refuse so that conservatives can express their pique over ‘Obamacare.’

Republican leaders say they’re worried about being saddled with a higher entitlement cost if the federal government reneges on its promise to pay its full share, but the design and history of Medicaid do does not support that concern. Meanwhile, there are billions of reasons to expand Medicaid now.”

Amen. Read the entire editorial by clicking here.