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.


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.



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.


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.


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.