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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.

Commentary

MarijuanaA bill to legalize medical marijuana, introduced by Representative Kelly Alexander, was considered by the House Judiciary I Committee today. Despite heart-wrenching testimony from veterans and others with serious medical conditions, the committee took less than thirty seconds to vote to give the bill an unfavorable report.

If passed, the bill would have allowed North Carolinians to obtain prescriptions and legally buy cannabis from licensed distributors. The distributors in turn would have purchased the plant from licensed growers, who would have been regulated by the Department of Agriculture. The bill would have taxed each sale of marijuana at 5% and created a revenue for the state.

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Commentary

Health careHard numbers and real life stories documented the impact of the Affordable Care Act today at an event in Durham commemorating the law’s fifth anniversary. “The Impact of the Affordable Care Act on Women” was a roundtable discussion that featured knowledgeable women from throughout Triangle region.

Women experts and advocates from Duke Regional Hospital, Enroll America North Carolina, the Durham County Commission, and Wake and Franklin Health Services were among those attending the event sponsored by the office of Congressman G.K. Butterfield and the U.S. Department of Health and Human Services at the Community Health Coalition in Durham. Congressman Butterfield joined the discussion via telephone and issued a call to action to continue the effort to reduce the number of uninsured in North Carolina. According to Butterfield, “Like the Civil Rights Act, the ACA is critical to ending discrimination, especially for women.”

Millions of women, of course, benefited directly from the ACA’s bar on being denied insurance because of “preexisting conditions” as well as the provision of subsidies to make health care more affordable. Women are more likely to experience social conditions such as poverty that act as barriers to accessing and utilizing health care.

Region Four of administrator, Dr. Pamela Roshell and senior advisor Stephanie Owens from HHS also participated in the panel and shared that, despite the numerous misconceptions about and attacks on the ACA, data show that 14.1 adults and 2.3 million children have gained health insurance and can now access primary and wellness care as a result of its implementation. In North Carolina, 560,000 residents are now insured as a result of the ACA – 70,000 of these individuals in the Raleigh-Durham area. Dr. Roshell congratulated our state on its enrollment and how the numbers are sending the message the ACA is needed and is working.

The roundtable discussion proceeded Read More